Taking care of your vision benefits.
The Pennsylvania Builders Association (PBA) Benefits Trust introduces the PBA Benefits Trust Vision Plan provided by National Vision Administrators, L.L.C. (NVA). Below is a summary of the schedule of benefits and rates available through the PBA Benefits Trust vision plan. Upon your enrollment, your employees will receive a more detailed overview of the plan including eligibility guidelines, customer service information and instructions for filing claims.
Schedule of Vision Benefits
Co-payment
None |
Participating
Provider |
Non-Participating Provider |
| Examination |
Under 19 Once Every 12 Months
19 & Over Once Every 24 Months |
Covered 100% |
Reimbursed Amount
Up to $32 |
| Lenses |
Under 19 Once Every 12 Months
19 & Over Once Every 24 Months |
Standard Glass or Plastic |
|
| Single Vision |
Covered 100% |
Up to $25 |
| Bifocal |
Covered 100% |
Up to $36 |
| Trifocal |
Covered 100% |
Up to $46 |
| Lenticular |
Covered 100% |
Up to $72 |
| Polycarbonate (under age 19 only) |
Covered 100% |
Not Covered |
| Frame |
| Once Every 24 Months |
Retail Allowance
Up to $60
(20% discount off balance)* |
Up to $30 |
| Contact Lenses** |
| |
In lieu of Lenses & Frame |
In lieu of Lenses & Frame |
| Under 19 Once Every 12 Months |
Up to $85 Retail |
Up to $85 |
19 & Over Once Every 24 Months
Elective Contact Lenses
Medically Necessary*** |
Up to $225 Retail |
Up to $225 |
| |
*Does not apply to Wal-Mart / Sam’s Club locations
** Fitting and Follow-Up Fees are deducted from the Contact Lens Allowance shown above
***Pre-approval from NVA required |
Lens options purchased from a participating NVA provider will be provided to the member at the amounts listed in the fixed option pricing list below:
- $10 Solid Tint $50 Progressive Lenses Standard
- $12 Fashion / Gradient Tint $65 Transitions Single Vision Standard
- $10 Standard Scratch-Resistant Coating $70 Transitions Multi-Focal Standard
- $12 Ultraviolet Coating $25 Polycarbonate (Single Vision)
- $40 Standard Anti-Reflective $30 Polycarbonate (Multi-Focal)
- $20 Glass Photogrey (Single Vision) $30 Blended Bifocal (Segment)
- $30 Glass Photogrey (Multi-Focal) $55 High Index
- $75 Polarized
Options not listed will be priced by NVA providers at their R&C retail price less 20%.
Wal-Mart / Sam’s Club Stores are NVA participating providers, however due to their everyday low prices Wal-Mart / Sam’s Club will not provide the lens options at the fees listed in the fixed option pricing list. Wal-Mart / Sam’s Club stores accept NVA for materials. Doctors affiliated with Wal-Mart / Sam’s Club are not Wal-Mart / Sam’s Club employees; therefore, participation for exams varies.
For a list of providers, please visit www.e-nva.com or call 800-672-7723.
Monthly Rates
These rates are effective through June 30, 2011.
|
| All Pennsylvania Counties |
Group Type |
Monthly Rates |
Single |
Non-Sole - $4.13
Sole - $4.43 |
2 Person or Family |
Non-Sole - $11.04
Sole - $12.14 |
Summary of Vision Care Benefits
National Vision Administrators, L.L.C. (NVA) has been contracted by your group to offer a comprehensive vision care plan to you and your eligible family members. Founded in January of 1979, NVA manages vision benefit services for approximately seven million lives nationwide.
How Your Vision Care Program Works
- When scheduling your appointment, please notify the NVA participating provider of your choice that your vision coverage is administered by NVA.
- The provider will contact NVA to verify eligibility.
- At the time of your appointment, simply present your NVA identification card to the provider or indicate clearly that your benefit is administered by NVA. A vision claim form is not required at an NVA participating provider.
- The provider will inform you of your eligibility status prior to rendering services.
- Be sure to inform the provider of your medical history and any prescription or over-the-counter medications you may be taking.
To verify your benefit eligibility prior to calling or visiting your eye care provider, please visit our website at www.e-nva.com or contact NVA’s Customer Service Department toll-free at 1.800.672.7723.
Eligibility: Eligible dependents under age 19 are entitled to receive a vision examination and one (1) pair of lenses once every 12 months from the last date of service and a frame once every 24 months from the last date of service or contact lenses once every 12 months from the last date of service. Eligible members and dependents age 19 and over are entitled to receive a vision examination and one (1) pair of lenses and a frame or contact lenses once every 24 months from the last date of service.
Regardless of medical or optical necessity, vision benefits are not available more frequently than specified in your policy.
Benefits at Participating Providers:
Highlights of your vision care benefit:
- The option of receiving services in- or out-of-network
- Extensive national provider network
- Enhanced in-network benefits:
- 100% covered Vision examination
- Allowance towards standard spectacle lenses
- Frame allowance covers countless fashionable frames in full
- Allowance towards the cost of contact lenses and fitting fees
- No claim forms; providers will submit claims directly to NVA.
Examinations: A comprehensive eye examination is covered which includes a case history, examination for pathology or anomalies, visual acuity (clearness of vision), refraction, and Tonometry testing (glaucoma). Comprehensive eye examinations can aid in the early detection of ocular diseases and other serious medical conditions.
Lenses: NVA provides coverage for standard glass or plastic eyeglass lenses.
Frames: Select any frame from the participating provider’s inventory. Any amount in excess of your plan allowance is the member’s responsibility, but discounted by 20%. Frame choices vary from office to office.
Contact Lenses: Elective contact lenses are covered in lieu of all other materials (i.e. spectacle lenses and frames). The contact lens benefit includes all types of contact lenses such as hard, soft, gas permeable and disposable lenses. Medically necessary contact lenses may be covered with prior authorization when prescribed for: post cataract surgery, correction of extreme visual acuity problems that cannot be corrected to 20/70 with spectacle lenses, Anisometropia or Keratoconus.
Discounts: There will be a twenty-percent (20%) discount off additional purchases of lenses and frames, excluding contacts at the time of service.
Non-Participating Providers: You will be responsible for one hundred percent (100%) of the cost at the time of service at a non-participating provider. To obtain direct reimbursement according to your plan design, you can print a claim form from www.e-nva.com. Please complete this form and submit along with an original or copy of the itemized receipt. If you cannot print the claim form you may submit receipts along with a letter containing the member’s full name, patient’s full name, address, ID# and sponsoring organization to NVA’s Clifton, NJ office. Remember, obtaining vision care services from a non-participating provider will result in greater out-of-pocket expense.
Exclusions / Limitations: No payment is made for medical or surgical treatments, Rx drugs or OTC medications, non-prescription lenses, two pair of glasses in lieu of bifocals, subnormal visual aids, vision examination or materials required for employment, replacement of lost, stolen, broken or damaged lenses, contact lenses or frames except at normal intervals when service would otherwise be available, services or materials provided by federal, state, local government or Worker's Compensation, examination, procedures training or materials not listed as a covered service, industrial safety lenses and safety frames with or without side shields, parts or repair of frame or sunglasses. Participating providers are not contractually obligated to offer sale prices in addition to outlined coverage.
Valuable Member Discounts
Laser Eye Surgery: NVA has chosen The National LASIK Network to serve their members. This network was developed by LCA Vision in 1999 and is one of the largest panels of LASIK surgeons in the U.S. Members are entitled to significant discounts and a free initial consultation with all in-network providers.
All providers are contracted to extend members discounts on standard prices or promotional prices, ensuring the member will pay less than the public.
- 15% off standard prices - or - 5% off promotional pricing
All-Inclusive Discount
- All in network providers extend the discount on the entire cost of the procedure, maximizing member savings.
Additional Member Value – Members are entitled to these additional benefits available exclusively at select providers (over 70 locations nationwide).
- Special “set prices” ranging from $695 to $1,895 per eye on select services
- Free initial consultation and comprehensive LASIK exam
- Advanced laser technologies including Wavefront and IntraLase
- Attractive financing options available
The process is simple:
- Find a provider (Call 1-877-295-8599 or visit www.e-nva.com)
- Schedule a pre-op exam to see if laser vision correction is right for you
- Schedule a treatment
- Pay discounted member price directly to the provider
Contact Fill: NVA provides you with the convenience and savings of Contact Fill, our mail order contact lens replacement service. You may access Contact Fill’s services online at www.contactfill.com or by calling them toll-free at 866.234.1393. Contact Fill provides contact lens wearers with significant savings packaged with the convenience of home delivery. Plan discounts applicable at participating retail locations do not apply to purchases made through Contact Fill due to the already low prices.
Plan Specific Details Online: The NVA website is easy to use and provides the most up to date information for program participants:
- Locate a nearby participating provider by name, zip code, or City/State
- Verify eligibility for you or a dependent
- View benefit program and specific details
- Review claims
- Print ID cards
- Nominate a non-participating provider to join the NVA network
If you are not a registered subscriber, you can still search our providers online by selecting the “Find a Provider” link at www.e-nva.com. Enter your group number on the identification card you will be receiving prior to your effective date and enter in your search parameters.
Customer Service: To verify eligibility, locate a participating provider and receive answers to all your vision care related inquiries, please call NVA’s Customer Service Department toll-free at 1.800.672.7723 (TDD: 973.574.2599).
- NVA’s Interactive Voice Response (IVR) system is available twenty-four (24) hours per day, seven (7) days per week. The IVR allows you to locate a participating provider in your area, check eligibility as well as the status of your claim(s).
- An NVA Customer Service Representative can be contacted Monday - Friday 8:00am - 6:00pm (ET) & Saturdays 8:30am - 5:00pm (ET)
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