Optical Assistance Program
Download Davis Vision Open Plan Reimbursement Claim Form
The Optical Assistance Program offers two optical plans. You can choose between the Optical Assistance Open Panel Plan and the Optical Assistance Closed Panel Plan, administered by Davis Vision.
- With the Optical Assistance Open Panel Plan you may receive services from any vision care provider you choose.
- With the Optical Assistance Program Closed Panel Plan you may receive services at any Davis Vision provider.
- If you need assistance finding a Davis Vision provider you can contact Davis Vision directly at 800-999-5431 or visit the Davis website www.davisvision.com, register and log in to the member secured portal and use the "find a Provider" tool. You can search for a closed plan Davis Vision provider by ZIP code, city, state, provider name or business name.
- Your Davis Vision ID# can be located on your Davis Vision ID Card. If you do not know your number you can call Davis Vision at 800-999-5431 or the NAGE Fund Office at 800-641-0700 to obtain it.
You must choose between the Open and the Closed Plan with Davis Vision. Benefits cannot be divided between the Open and Closed Panel Plans.
Benefit Information Notice
Members who have been reimbursed for benefits under the Commonwealth of Massachusetts/NAGE Optical Assistance Program will not be eligible for benefits until the next eighteen (18) month eligibility period (twelve (12) months for dependents less than nineteen (19) years of age) has been completed. The eligibility period starts from he date of your last service. Contact the Fund Office or Davis Vision directly at 1-800-999-5431 or you can go to their website at www.davisvision.com to verify your eligibility date.
If you are in need of an eye examination prior to your eighteen month eligibility date with the Fund, contact your health insurance carrier to see if you are eligible for coverage.
- Coverage is for a routine eye examination and prescription corrective eyewear only
- Benefits for medical treatment of eye disease or injury are not provided for under this program
- If you received coverage for your eye examination from your health insurance carrier you will be reimbursed for your co-payment only up to the $50.00 maximum
THE OPEN PANEL OPTICAL PLAN
- You may receive services from any vision care provider you choose. In order to seek reimbursement up to the maximum allowed under the open plan benefit schedule, you MUST submit your paid vision bills for an examination and materials at the same time, along with your claim form, signed by the participant and the service provider to Davis Vision for reimbursement.
- Only one claim will be allowed for each eighteen (18) month period or each twelve (12) month period for dependents less than nineteen (19) years of age.
- You MUST submit all of your paid bills for an eye examination and vision wear material at the SAME TIME. SERVICE/MATERIALS MAXIMUM REIMBURSEMENT
- Eye Examination $ 50.00
- Glasses (lenses and frames) $200.00
- Eye Exam with Contact Lenses $200.00
(Daily wear or Disposable)
- Replacement of Lost or Broken Glass $200.00
(in place of any other vision or contact lens benefit)
The following items will not be covered:
a) Safety Glasses,
b) Cosmetic materials such as non-prescription and prescription sunglasses, photo grey lenses, tinted lenses,
c) Non-prescription reading glasses,
d) Plano lenses,
e) Eyewear for sports,
f) Cosmetic contact lenses with different eye color.
Completely fill in the claim form and be sure you attach a copy of the paid itemized statement to the form.
IF ALL QUESTIONS ARE NOT ANSWERED OR DOCUMENTS ARE NOT INCLUDED,
THE CLAIM WILL NOT BE PROCESSED.
DO YOU PARTICIPATE IN A FLEXIBLE SPENDING PLAN?
A Flexible Spending Plan is a program that allows you to have a designated dollar amount of your paycheck put aside and held in an account until you need to use it for out-of-pocket healthcare expenses. The money is deducted before taxes are paid, allowing you to apply 100 percent of the money you earn and put aside toward eligible expenses.
The out-of-pocket cost for vision care is an eligible expense under a Flexible Spending Plan, including eyeglasses, contact lenses and their upkeep, prescription sunglasses, non-prescription reading glasses, laser eye surgery and examination fees. For additional information call The Group Insurance Commission Health Care Spending Account Administrator at 1-866-862-2422 or visit the Group Insurance Commission web site at the link below.