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Note: Changing the start date may alter the price.


Total Monthly Cost
$0.00
One-Time Enrollment Fee
$35.00

First Month’s Payment
$35.00

Future monthly payments will be $35.00

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Choice Plan Offered by VSP

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  • Details
  • In-Network
  • Out-of-Network
  • FAQ

Plan Details

Eye Examination ($15 Copay, every 12 mo)
Covered in full (includes dilation when professionally indicated)

Spectacle Lenses
Lenses (every 12 mo)
  • Single vision: $35, lined bifocal: $55, and lined trifocal lenses: $65
Frames (every 24 mo)
  • Up to $70 retail price, member pays $40
  • Over $70 retail price, member pays $40 plus 10% balance
Contact Lens Care (No Copay, every 12 mo)
  • 15% off provider’s UCR for contact lens evaluation
  • 20% off provider's UCR for contacts

Extra Discounts and Savings

Glasses and Sunglasses

20% off additional prescription and non-prescription glasses and sunglasses not covered by the benefit.

Contacts *

15% off provider’s UCR

Laser Vision Correction

Up to 25% discount off participating provider's UCR or 5% off advertised special (whichever is lower).

Out of Network Benefits

You receive the greatest value by staying in-network. If you go out-of-network, pay the provider at the time of service, then submit a claim to Davis Vision for reimbursement.

Benefit Name Benefit Amount
Exam Up to $34
Single Vision Lenses Up to $17
Bifocal Lenses Up to $30
Trifocal Lenses Up to $43
Frame Up to $38.25
Elective Contacts Up to $100

Benefits (In-Network)

Benefit Copay Frequency
Eye Exam $10.00 every 12 months
Rx Glasses $20.00 Lenses: every 12 months (in lieu of contacts)
Frames: every 24 months
Contacts No Copay every 12 months (in lieu of lenses)

Your Coverage from a VSP Doctor

WellVision Exam® $10.00 Copay, available every 12 months
Prescription Glasses $20.00 Copay
Lenses (available every 12 mo)
  • Single vision, lined bifocal, and lined trifocal lenses
  • Polycarbonate lenses for dependent children
Frames (available every 24 mo)
  • $130 allowance for frame of your choice
  • Plus 20% off any out-of-pocket costs
OR
Contact Lens Care No Copay, available every 12 months
  • $130 allowance for contacts and the contact lens exam.

Extra Discounts and Savings

Glasses and Sunglasses
  • 20%-25% savings on non-covered lens options
  • 20% off additional prescription and non-prescription glasses and sunglasses, including lens options from any VSP doctor within 12 months of your last covered eye exam
Contacts*
  • 15% off cost of contact lens exam
Laser Vision Correction
  • Average 15% off the regular price or 5% off the promotional price. Discounts only available from contracted facilities.

Benefits (Out of Network)

If you see a non-VSP provider you will receive a lesser benefit. Before seeing a non-VSP provider, call us at 800.877.7195 for more details.

Benefit Reimbursement Amount
Exam Up to $34
Single vision lenses Up to $17
Lined bifocal lenses Up to $30
Lined trifocal lenses Up to $43
Frame Up to $38.25
Contacts Up to $100
VSP guarantees service from VSP doctors only. In the event of conflict between this information and your organization's contract with VSP, the terms of the contract will prevail.

Frequently Asked Questions

When will my first payment be taken?

The $35 non-refundable enrollment fee plus your first months premium is due at time of enrollment.

Banking/Saving account: Please allow up to 3 business days.
Credit/Debit Card: Will be taken immediately.

Are there any exclusions to the vision benefits?

Your vision plan does not cover medical treatment of eye disease or injury; vision therapy; special lens designs or coatings, other than those described herein; replacement of lost eyewear; non-prescription (plano) lenses; contact lenses and eyeglasses in the same benefit cycle; services not performed by licensed personnel; two pair of eyeglasses in lieu of bifocals.

Do I need a claim form?

Claim forms are only required if you visit an out-of-network provider. Claim forms are available on the www.davisvision.com member website.

How can I contact Davis Vision Member Services?

Call 1-800-999-5431 (TTY services available at 1-800-523-2847).

Live Help Hours:

Mon – Fri: 8am – 11pm
Saturday: 9am – 4pm
Sunday: 12pm – 4pm (EST)

Automated help is available 24/7.

Can I use an out-of-network provider?

Yes; however, you receive the greatest value by staying in-network. If you go out-of-network, pay the provider at the time of service, then submit a claim to Davis Vision for reimbursement, up to the following amounts:

  • Eye Exam $34
  • Single Vision Lenses $17
  • Bifocal $30
  • Trifocal $43
  • Lenticular $60
  • Frame $38.25
  • Elective Contacts $100
  • Medically Necessary Contacts $225

When will I receive my eyewear?

Your eyewear will be delivered to your network provider generally within five business days of order receipt. Special prescriptions, lens coatings, provider frames or out-of-stock frames may delay the standard turnaround time.

What frames are in Davis Vision’s Collection?

Our Collection offers a great selection of fashionable and designer frames, most of which are covered in full. No wonder 8 out of 10 members select a Collection frame. Log on to our Davis Vision member Website at www.davisvision.com and take a look!

Can I split my benefits?

You may split your benefits by receiving your eye examination and eyeglasses or contact lenses on different dates or through different provider locations. To maximize your benefit value we recommend that all services be obtained from a network provider.

What should I expect to see on my Bank/Credit Card Statement for my premium payments?

Insurance 8888593795 will appear on your statement as the charge for your premiums.

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  • Start Date: 03/01/2020
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Ineligible Occupations

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If the Applicant or Proposed Insured holds one of these occupations, please check the box next to that individual’s name in the application. These individuals will not be eligible for coverage with the Standard Life product.

  • Active Military Personnel
  • Asbestos Workers
  • Atomic or Nuclear Energy Workers
  • Crop Dusters
  • Explosive Workers/Pyrotechnical (dynamite, TNT, etc.)
  • Hazardous Chemical Exposure Environment
  • Offshore Workers (oil well drilling/operations)
  • Professional Athletes (except golfers and bowlers)
  • Quarry Workers
  • Stunt Activity (flying, aerobatics)
  • Toxic Waste Handlers
  • Underground Miners
  • Unemployed (Report this for the Primary Applicant only)

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Standard Life — Uninsurable Medical Conditions

If the Applicant or Proposed Insured has had abnormal test results, treatment or been recommended to have treatment for any of the following conditions within the last 5 years, please check the box next to that individual’s name in the application. These individuals will not be eligible for coverage with the Standard Life product.

  • Acquired Immune Deficiency Syndrome (AIDS)
  • AIDS Related Complex (ARC)
  • Alcohol or Drug Abuse
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  • Fibromyalgia
  • Heart Attack
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  • Hepatitis
  • Human Immunodeficiency Virus (HIV)
  • Insulin Dependent Diabetes
  • Internal Cancer
  • Kidney Disease
  • Liver Disease
  • Lou Gehrig’s Disease (ALS)
  • Lung Disease (All Others)
  • Lupus Erythematosus
  • Major Depression
  • Melanoma Cancer
  • Multiple Sclerosis
  • Muscle Disease ON D
  • Muscular Dystrophy
  • Myositis
  • Organ Failure
  • Organ Transplant
  • Organic Brain Syndrome
  • Osteoporosis with History of Bone Fracture
  • Paralysis (any Type of Degree)
  • Peripheral Vascular Disease
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  • Senile Dementia
  • Stroke
  • Substance Abuse
  • Transient Ischemic Attack (TIA)
  • Ulcerative Colitis
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Based on the information you provided, one or more of your dependents is not eligible for the Limited Medical Plan. The coverage and rate have been adjusted accordingly.

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