The Pennsylvania Builders Association Benefits Trust is proud to offer our members the following vision insurance plan.

Benefit Summary

Please Note: Contact lenses can be worn by most people. Once the contact lens option is selected and the lenses are fitted, they may not be exchanged for eyeglasses.

• Disposable contact lens wearers will receive four multi-packs of lenses. Planned replacement contact lens wearers will receive two multi-packs of lenses.

Monthly Rates

These rates are effective July 1, 2008 through June 30, 2009 for new groups and include the PBA Benefits Trust administrative fee. Please note, groups that enrolled between July 1, 2007 and May 30, 2008 will keep their current rates.

Frequently Asked Questions
How do I receive services from a provider in the network?

• Call the network provider of your choice and schedule an appointment.
• Identify yourself as Davis Vision plan participant.
• Provide the office with the employee's ID number and the date of birth of any covered children needing services. It's that easy! The provider's office will verify your eligibility for services, and no claim forms or ID cards are required!
  
  

Who are the network providers?
They are licensed providers who are extensively reviewed and credentialed to ensure that stringent standards for quality service are maintained. Please call 1-800-999-5431 to access the Interactive Voice Response (IVR) Unit, which will supply you with the names and addresses of the network providers nearest you, or you may access our website at www.davisvision.com and utilize our "Find a Doctor" feature.

What about out-of-network provider benefits?
You may receive services from an out-of-network provider, although you will receive the greatest value and maximize your benefit dollars if you select a provider who participates in the network. If you choose an out-of-network provider, you must pay the provider directly for all charges and then submit a claim for reimbursement to:

    Vision Care Processing Unit
    P.O. Box 1525
    Latham, NY 12110

To request claim forms, please visit the Davis Vision website at www.davisvision.com or call 1-800-999-5431.

What lenses/coatings are included?

• Plastic or glass single vision, bifocal or trifocal lenses, in any prescription range.
• Oversize lenses.
• Post-cataract lenses.
• Fashion, sun or gradient tinted prescription plastic lenses.
• Polycarbonate lenses for dependent children, monocular patients and patients with prescriptions +/- 6.00 diopters or greater.
  
  

Are there any optional frames, lens types or coatings available?
Yes, you can pay the low, discounted fixed fees indicated and receive these exciting optional items:

• $20.00 for a Designer frame from the "Tower Collection".
• $40.00 for a Premier frame from the "Tower Collection".
• $15.00 for glass grey #3 prescription lenses.
• $35.00 for polycarbonate lenses.
• $20.00 for scratch-resistant coating.
• $20.00 for Photogrey ExtraÆ (photosensitive) glass lenses.
• $15.00 for ultraviolet (UV) coating.
• $40.00 for standard ARC (anti-reflective coating). Premium ARC is $55.00.
• $75.00 for polarized lenses.
• $30.00 for intermediate vision lenses.
• $20.00 for blended invisible bifocals.
• $70.00 for plastic photosensitive lenses.
• $60.00 for high-index (thinner and lighter) lenses.
• $65.00 for standard progressive addition multifocal lenses. Premium progressive additional lenses are $105.00.**

** Progressive addition multifocals can be worn by most people. Conventional bifocals will be supplied at no additional charge for anyone who is unable to adapt to progressive addition lenses; however, the copayment will not be refunded.

Laser Vision Correction Services:
Davis Vision is pleased to provide you and your eligible dependents with the opportunity to receive Laser Vision Correction Services at significant discounts through a network of experienced, credentialed surgeons (please note that some providers have flat fees equivalent to these discounts). For more information, please visit our website at www.davisvision.com or call 1-800-999-5431.

Mail Order Contact Lenses:
Free membership and access to a mail order replacement contact lens service, Lens 123, providing a fast and convenient way to purchase replacement contact lenses at significant savings. For more information, please call 1-800-LENS-123 (1-800-536-7123) or visit the Lens 123 web site at www.Lens123.com.

Your rights as a patient:
Davis Vision recognizes that all patients have specific rights, including, but not limited to:

• The right to complete information about their healthcare options and consequences.
• The right to participate in all treatment decisions.
• The right to dignity, privacy, confidentiality and non-discrimination.
• The right to complain or appeal any decision. Patients also have the responsibility:
• To provide complete and accurate information.
• To follow care instructions.

For a complete copy of Your Rights and Responsibilities As a Patient, please visit our website at: www.davisvision.com or call 1-800-999-5431.

For additional information:
Please call Davis Vision at 1-800-999-5431 with questions or visit our website: www.davisvision.com. Member Service Representatives are available: Monday through Friday, 8:00 AM to 8:00 PM, Eastern Time, and; Saturday, 9:00 AM to 4:00 PM Eastern Time. Participants who use a TTY (Teletypewriter) because of a hearing or speech disability may access TTY services by calling 1-800-523-2847.

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