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Summary of Fashion Focus Option V Benefits

Benefit Network Out-Of-Network Reimbursment1 
Frequency2
Eye examination
(including dilation, as professionally indicated)
Once every 12 months Once every 12 months
Eyeglass Lenses Once every 12 months Once every 12 months
Frames Once every 12 months Once every 12 months
Contact lenses (in lieu of eyeglass lenses) Once every 12 months Once every 12 months
Eye Examination
Eye Examination
(including dilation as professionally indicated)
Covered In Full Plan pays up to $40
Frames3
Fashion level frames from "The Collection" Covered In Full  
Designer level frames from "The Collection" Member pays $20  
Premier level frames from "The Collection" Member pays $40  
Retail allowance towards a provider's frame Plan pays up to $60 Plan pays up to $30
Retail allowance towards a frame from VisionWorks Plan pays up to $110 Plan pays up to $30
Standard Eyeglass Lenses3 (per pair)4
Single vision Covered In Full Plan pays up to $35
Bifocal Covered In Full Plan pays up to $40
Trifocal Covered In Full Plan pays up to $45
Lenticular Covered In Full Plan pays up to $50
Optional Eyeglass Lenses (per pair)
Standard progressive lenses 5 Member pays $50 Not Covered

Premium progressive lenses 5

Member pays $90

Not Covered
Glass Grey #3 prescription sunglasses Member pays $11 Not Covered
Adult 6 - Polycarbonate lenses Member pays $30 Not Covered
Dependent children
Single vision Polycarbonate lenses (in lieu of single vision eyeglass lenses)
Covered In Full Not Covered
Dependent children
Bifocal Polycarbonate lenses (in lieu of bifocal eyeglass lenses)
Covered In Full Not Covered
Dependent children
Trifocal Polycarbonate lenses (in lieu of trifocal eyeglass lenses)
Covered In Full Not Covered
Blended segment lenses Member pays $20 Not Covered
Intermediate vision lenses Member pays $30 Not Covered
Glass photochromic lenses Member pays $20 Not Covered
Plastic photosensitive lenses Member pays $65 Not Covered
High-index (thinner and lighter) lenses Member pays $55 Not Covered
Polarized lenses Member pays $75 Not Covered
Optional Eyeglass Lens Coatings/Treatments
Fashion, sun or gradient tinted plastic lenses Member pays $11 Not Covered
Ultraviolet Coating Member pays $12 Not Covered
Scratch-resistant coating Member pays $20 Not Covered
Standard ARC (anti-reflective coating) Member pays $35 Not Covered
Premium ARC (anti-reflective coating) Member pays $48 Not Covered
Ultra ARC (anti-reflective coating) Member pays $60 Not Covered
Contact Lenses7
(in lieu of eyeglass lenses—per pair or initial supply of disposable contact lenses)
Contact lens evaluation and fitting
- Daily wear
Covered In Full Plan pays up to $20
Contact lens evaluation and fitting
- Extended wear
Covered In Full Plan pays up to $30
Standard daily wear contact lenses Covered In Full Plan pays up to $48
Specialty contact lenses Plan pays up to $90 Plan pays up to $50
Disposable contact lenses Plan pays up to $90 Plan pays up to $50
Medically necessary contact lenses (prior approval required) Covered In Full Plan pays up to $225
Low Vision Services
Evaluation – one visit every 5 years (prior approval required) Plan pays up to $300 per visit
Follow-up visits—up to four follow-up visits every 5 years Plan pays up to $100 per visit
Low vision aids Plan pays up to $600 per aid
$1,200 lifetime maximum

1 If you choose an out-of-network provider, you must pay the provider directly for all charges and then submit a claim for reimbursement.

2 Eligibility will be determined from the date of the last similar service paid under this program, or any other Highmark vision program for this group.

3 Safety glasses are eligible in lieu of Dress frames and Dress lenses for the employee only.

4 Includes glass, plastic or oversized lenses. Includes safety glasses.

5 Progressive 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 lenses. However, the discounted price will not be refunded.

6 Discounted member price waived for monocular patients and patients with prescriptions +/- 6.00 diopters or greater.

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

Network Providers

The Davis Vision provider network is being used through a contractual arrangement between Davis Vision and Highmark. Davis Vision is an independent company that manages a network of licensed vision providers in both private practice and retail locations. Network providers are reviewed and credentialed to ensure that standards for quality and service are maintained.

Network Retail Locations

In order to provide you with the greatest amount of flexibility and convenience, the network includes a number of retail establishments. Benefits at the retail locations may vary slightly from other locations, as noted in this benefit description. However, your value is comparable.

Locating a Network Provider

 To find a network provider, go to www.highmarkblueshield.com and click on "Find a Doctor or Rx". Click on “Find an Eyecare Provider” Enter your zip code and mile radius then click on “Search” to see the most current listing of providers that will accept your vision plan.

Receiving Services from a Network Provider:

  • Call the network provider of your choice and schedule an appointment.
  • Identify yourself as a Highmark member, or eligible dependent, in a vision plan administered by Davis Vision.
  • Provide the office with your identification (ID) number (located on your Highmark ID card), and the name and birth date of the covered dependent receiving services.

It's that easy! The provider's office will verify your eligibility for services. No claim forms are required.

Frame Benefit

You may choose from the Fashion selection from 'The Collection' in most independent network provider offices or a program allowance will be applied toward a network provider's own frames. Many Collection frames are covered in full or have a nominal copayment which helps you select high-quality frames while minimizing out-of-pocket expenses. Network retail providers typically do not display the Collection. You will instead be given a program allowance toward your frame purchase. If the chosen frame exceeds the allowance, you will be responsible for any remaining balance.

Contact Lenses Benefit

Contact lenses may be selected in lieu of eyeglass lenses. No copayment applies towards the initial supply of formulary contact lenses (many of the most popular standard, soft daily wear; disposable or planned replacement) including fitting/follow-up charges. A program allowance will be applied toward contact lenses from the provider's own supply (which may or may not include fitting/follow-up charges). At a network retail location, you will receive an allowance toward the cost of lenses from the retailer’s supply. With prior approval, medically necessary contact lenses will be covered in full at all network provider locations.

Low Vision Services

You and your covered dependents are entitled to a comprehensive low vision evaluation once every five years and low vision aids up to the plan maximum. Up to four follow-up visits will be covered during the five-year period.

Exclusions

This vision program excludes coverage for certain items and services, including: medical treatment of eye disease or injury; vision therapy; special lens designs or coatings other than those previously described; replacement of lost or stolen eyewear; non-prescription (plano) lenses; and services not performed by licensed personnel.

Value-Added Features

Replacement Contact Lens Program

Highmark offers a contact lens replacement program to members. This mail order program exclusively allows you to enjoy the guaranteed lowest prices on contact lens replacement materials. Visit www.davisvisioncontacts.com or call 1-855-589-7911 with a current prescription. Every order comes with a complimentary starter kit.

Laser Vision Correction 

Highmark members enjoy lower prices on LASIK procedures than other carriers, along with flexible financing options - up to 12 months interest free. These savings are up to 40% - 50% off the national average price of traditional LASIK and are available at over 1,000 locations across our nationwide network of laser vision correction providers. 

Laser vision correction services are administered by QualSight, LLC. Terms and conditions are subject to change.

 

Contact

Call Member Service Monday through Friday, 8:00 am to 5:00 pm, Eastern Standard Time (EST) at 1-800-223-4795 (TTY users call 1-800-523-2847) to find a network provider, ask benefit questions, verify eligibility or request an out-of-network provider reimbursement form. For information prior to enrolling, call 1-800-223-4795.