Vision Plan: It Pays to Know the Details

If you have had an opportunity to use the vision plan since EyeMed Vision Care replaced Davis Vision on January 1, 2007, you may have noticed some differences.  This is especially true when it comes to choosing frames for your eyeglasses when using an in-network vision care provider.

Frame Collection vs. Frame Allowance

Davis Vision offered a collection of fashion and designer frames from which you had to choose in order to get a paid-in-full benefit.  Through the Upgrade Program, you had the option of choosing from a collection of premier frames and paying a fixed, reduced fee.  During calendar year 2006, the discounted fee for premier frames was $22.74.  If you did not choose a frame from one of these collections, it was considered a non-plan covered frame.  Davis Vision paid the provider $16 to apply to the retail cost of non-plan covered frames.  You paid the difference between the total retail cost and the $16 allowance.

EyeMed does not limit you to a specific collection of frames.  You may choose any frame offered by an in-network provider. The benefit for eyeglass frames is based on an allowance. You have $100 to apply to the retail cost of frames. If you choose a frame that costs more than that, you will receive a 20% discount on the balance.  In other words, you pay 80% of the retail cost exceeding $100. For example, if the frame costs $200, you will pay $80 (80% of $100).

PEF has filed a grievance asserting that the state has diminished our members’ vision care benefits by changing the paid-in-full benefit for eyeglass frames from a collection of frames to an allowance of $100.  Members have advised us that they do not have the same amount of choice when selecting a paid-in-full frame at an EyeMed in-network provider location.  As a result, they are paying more out-of-pocket in order to purchase eyeglasses that meet their expectations.  Members who are dissatisfied with the selection of eyeglass frames should contact PEF’s Health Benefits Specialist, Lorraine Simpkins, at PEF headquarters.

Frame Selection Varies from Provider to Provider

Another difference between Davis Vision and EyeMed is the selection of frames available at in-network provider locations.  Davis Vision required all in-network providers to offer the same collection of frames.  Since they owned and operated the Empire Vision Centers and Davis Vision Centers, they offered additional frames at these locations.  There was little, if any, difference between the selection of frames at one in-network Empire Vision Center or Davis Vision retail chain store and another.  The same was true among the non-chain store locations.

EyeMed allows its in-network providers to decide which frames they will offer.  As a result, the selection of frames will vary, and may vary considerably, from one in-network provider location to another.  This means that the number of frames with a retail cost of up to $100 will be different from one retail chain to another (e.g., LensCrafters to Sears Optical) or one independent, non-retail chain store location to another.

Return Policies and Eyeglass Warranties

Return policies and eyeglass warranties also differ between Davis Vision and EyeMed.  Davis Vision provided a 30-day return policy on all plan-covered eyeglasses purchased at an in-network provider location, and a one-year unconditional warranty against defect or breakage.  Return policies and eyeglass warranties vary among EyeMed in-network providers. LensCrafters advertises a 30-day return policy on eyewear purchased from their stores. Eyewear purchased from independent, non-retail chain store locations are subject to the warranties given by that provider and/or the eyewear manufacturer. Eyewear made by laboratories owned by Luxottica, the parent company of EyeMed, is fully-guaranteed for 1 year against any defects in materials and/or workmanship.

Important to “Shop Around” for Best Selection and Value

Given the differences in the selection of frames and the return policies and eyeglass warranties, we are encouraging members to “shop around” before scheduling an appointment with an in-network vision care provider.  Visit the different retail chain stores in the network and determine if the choice of frames within your budget is satisfactory.  Ask about the store’s return policy and eyewear warranties.  By doing some comparison-shopping ahead of time, you are likely to be more satisfied with your eyewear purchase and may save yourself some money in the process.

NYS Vision Plan Upgrade Program

PEF members and their covered dependents may upgrade their eyeglass lens options and coatings through the Upgrade Program.  Under the Upgrade Program, members may purchase optional benefit enhancements from in-network vision care providers at reduced fixed prices.  The enhancements available through the Upgrade Program include plastic photosensitive lenses (e.g., Transitions® lenses), blended invisible bifocal lenses, progressive addition multifocal lenses, polycarbonate lenses (when not paid-in-full), high index lenses, anti-reflection coating and scratch-resistant coating.

The change from Davis Vision to EyeMed Vision Care effective January 1, 2007, did result in a change in the reduced fixed prices under the Upgrade Program.  For most of the enhancements, the EyeMed discounted fee is lower than the Davis Vision fee.

Comparison of the Discounted Fees

A comparison of the discounted fees for all of the enhancements is indicated below:

Questions/Assistance with Problems

If members have any questions regarding the Upgrade Program, they should first contact the EyeMed Customer Care Center at 1-877-226-1412.  If additional assistance is needed, members may contact PEF’s Health Benefits Specialist, Lorraine Simpkins, via e-mail at lsimpkins@pef.org, or by calling PEF headquarters at (518)785-1900 or 1-800-342-4306, ext. 283.