Have you had an eye exam lately? Learn how you can save money on eye care with the Davis Vision® Eye Care Program With the Davis Vision eye care program you can get a comprehensive eye examination for only $35 at Davis Vision network providers nationwide. This program also offers significant discounts on frames, lenses, and contact lenses. See the back of this flyer for more details. Through Lens123®, the Davis Vision proprietary mail order program, you may receive replacement contact lenses offered at guaranteed, discounted prices. Thinking about laser vision correction? You can receive discounts on laser vision correction services at Davis Vision participating laser vision correction providers: up to 25 percent off the participating provider’s usual and customary fees or 5 percent off any participating provider’s advertised specials, whichever is less. Who is eligible to participate in this program? Through Independence Administrators, Davis Vision Eye Care Program is being offered to all full-time students at your school — whether or not you are enrolled in your school’s health plan. How do I get started? I am enrolled in the Independence Administrators Student Health Plan Just show your Independence Administrators ID card at any Davis Vision network provider to get your $35 comprehensive eye exam and other discounts. Register and log in to our Member site at www.DavisVision.com to learn more about your vision care discount program and to locate network providers. I am not currently enrolled in the Independence Administrators Student Health Plan Call 877-393-7804 to get a Davis Vision ID number, then register online at www.DavisVision.com. Then print and go. After you register at www.DavisVision.com, print your ID card and take it to a Davis Vision network provider. You can also find network providers online. Make an appointment. Tell your provider that you are a Davis Vision member. Provide your member ID number, name, and date of birth. Your provider will take care of the rest. There is no fee to enroll in this program. For more details about the program and discounts Visit www.DavisVision.com and go to Members. Under Open Enrollment, enter 3077 in the Client Code field. www.DavisVision.com 877-393-7804 Member Discount Fee Schedule This information is subject to change at any time; please register and log in to our Member site at www.DavisVision.com to learn more about your vision care discount program. Service Member Cost Eye Examinations Routine eye examination with dilation (once every year) Covered in full after a $35 copayment to a Davis Vision participating provider You will receive up to a $30 reimbursement if you receive your eye examination at a non-participating provider. Frames Priced up to $70 retail Priced above $70 retail $40 $40, plus 10% off the amount over $70 Spectacle Lenses Single vision $35 Bifocal $55 Trifocal $65 Lenticular $110 Lens Options (add to spectacle lens prices above) Standard progressive $75 Premium progressive $125 Glass lenses $18 Polycarbonate lenses $30 Blended invisible bifocals $20 Intermediate vision lenses $30 Photogrey Extra lenses $35 Scratch-resistant coating $20 ARC (anti-reflective coating) $45 Ultraviolet (UV) coating $15 Solid tint $10 Gradient tint $12 Plastic photosensitive lenses $65 Polarized lenses $75 ® Contact Lenses Conventional 20% off usual and customary Disposable/planned replacement 10% off usual and customary Lens 123 mail order contact lens replacement program ® up to 50% off retail prices Other Products Laser vision care services Up to 25% off usual and customary or receive an additional 5% discount on any advertised specials (whichever is lower) Non-prescription sunglasses 20% off usual and customary Other ancillary products/solutions 10% off usual and customary Eyewear discount schedule is available only at Davis Vision participating providers. Special lens designs, materials, powers, and frames may require additional cost. At Wal-Mart and Sam’s Club locations, members will receive comparable values through their everyday low price on an eye examination, frame, and contact lens purchases. Davis Vision ® is an independent company offering vision care and eyewear services to Independence Administrators. Independence Administrators is an independent licensee of the Blue Cross and Blue Shield Association IA_STUDENT_DAVIS_VISION_201207