Vision Benefits
Even if you think you have perfect vision, a routine eye exam can be one of the best things you can do to protect the overall health and wellness of you and your loved ones. Your eyes are often a very effective window to your overall health. During a comprehensive eye exam, your eye doctor can observe and evaluate the health and condition of the blood vessels in your retina, which are good predictors of the health of blood vessels throughout your body. Conditions such as diabetes, hypertension, and hypercholesterolemia are visible by changes in the appearance of the retinal blood supply and blood vessels.
Routine eye exams are especially important for any with diabetes or who may be at risk for the disease due to family history, obesity, or other reasons. In its early stages, diabetic eye disease has no visible symptoms. Only a comprehensive eye exam can detect signs of the disease to prevent vision loss.
People who fail to have routine eye exams and develop glaucoma typically become aware of it only after they’ve sustained permanent vision loss from the disease. And by that time, controlling glaucoma to prevent additional vision loss can be very difficult. Without successful control with medical treatment and/or glaucoma surgery, the disease can lead to blindness. Early detection of high eye pressure and other risk factors for glaucoma is possible only with routine eye exams.
Vision benefits are provided through National Vision Administrators (NVA). Members may use any provider; however, if you use an NVA participating provider, you will be charged a discounted price and the provider will submit the claim for you. If you do not use an NVA participating provider, you must pay the provider the full amount and then submit the paid invoice to NVA for reimbursement, subject to the applicable limits. Be sure to tell the NVA participating providers that you are covered through NVA at the time you make your appointment and take your card with you to the appointment.
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Members receive an eye exam once every two calendar years.
Participating provider:
- 100% paid after $5 copay
Non-participating Provider:
- Up to $30
*Higher copays may apply for contact lenses examinations.
Members receive lenses once every two calendar years. Lens options will be priced by NVA Providers at their wholesale price plus 25%.
Participating Provider:
- 100% paid for standard glass or plastic lens
Non-participating Provider:
- Single Vision – Up to $25
- Bifocal – Up to $35
- Trifocal – Up to $45
- Lenticular – Up to $75
Members can receive frames once every two calendar years. Provider will charge the difference between the wholesale cost and the plan allowance plus 20%.
Participating Provider:
- Wholesale Allowance up to $40
Non-participating Provider:Â
- Up to $25
The Fund pays 100% for the remainder of the year once you reach your MOOP limit. MOOP Limit includes examination copayments and purchase of standard frames and lenses, but does not include additional costs for upgraded frames, lenses, and contacts.
MOOP Limit:
- $25 per person
- $50 family maximum
Members can receive contact lenses once every two calendar years, in lieu of Lenses & Frame. Pre-approval required from NVA for Medically Necessary.
Elective:Â The contact lens benefit includes all types of contact lenses such as hard, soft, gas permeable, and disposable lenses.
- Up to $105, plus routine eye exam
Medically Necessary:Â 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.
- Up to $150, including routine eye exam
Lens options purchased from a participating NVA Provider will be provided to the Member at the amounts listed.
- $10 Solid Tint
- $12 Fashion/Gradient Tint
- $10 Standard Scratch-Resistant Coating
- $12 Ultraviolet Coating
- $40 Standard Anti-Reflective
- $20 Glass Photogrey (single vision)
- $30 Glass Photogrey (multi-focal)
- $75 Polarized
- $50 Progressive Lenses Standard*
- $65 Transitions Single Vision Standard
- $70 Transitions Multi-Focal Standard
- $25 Polycarbonate (single vision)
- $30 Polycarbonate (multi-focal)
- $30 Blended Bifocal (segment(
- $55 High Index
- $100 Progressive Lenses Premium*
*Fixed pricing not available on certain brands.
Options not listed will be priced by participating NVA Providers at the wholesale cost plus 25%.
In addition to your funded benefit, Members are eligible to access the EyeEssential® Plan discount (in network only) on additional purchases during the plan period. Please contact NVA for details.
Service by a Non-Participating Provider
If a Non-Participating Provider is used, Members are responsible for paying 100% of the cost at the time of service. You must then request reimbursement from NVA. To receive reimbursement:
- Complete a “Claim for Vision Care Expense” form. Forms can be downloaded here or at e-nva.com.
- Scan and submit form by email to: vi**********@e-***.com
- Or Fax form to 973-574-2430
- Or mail completed claim form and itemized receipt (copy or original) to:
National Vision Administrators
PO Box 2187
Clifton, NJ 07015
- If you cannot print the claim form, you may submit receipts along with a letter containing Member’s full name, patient’s full name, address, ID number, and OLDC-OCA Insurance Fund.
Remember, obtaining vision care services from a Non-Participating Provider will result in greater out-of-pocket expenses for you.
NVA App Available
You can take NVA with you anywhere you go with the NVA mobile app. The NVA app is ready to download on Google Play for Android users and the App store for iPhone users. Simply download the app on your mobile device to get started. Find the app by typing NVA vision in the search box at the online stores. Only NVA active cardholders can access the NVA vision benefits member app at this time. Dependents cannot access the app.
With the NVA vision benefits member app, users can:
- Find an in-network vision care provider nearby, call the provider to setup an appointment, and get driving directions.Â
- Check benefit information on eye exams, eyeglass lenses and frames, and contact lenses.Â
- See the last time the benefit was used and the next time it can be used.Â
- View ID card
- Access the NVA Smart Buyer® to learn how prescription dictates the choice in lenses and frames, the pros and cons of lenses and lens options along with estimated retail pricing, factors to consider when selecting frames, and more.Â
- Create an account, reset password and/or username, reset security question and change e-mail address associated with the account (you can use the same username and password if you created one on the NVA website).Â
Additional Vision Benefits
NVA has partnered with The National LASIK Network to offer certain discounts. Members are entitled to significant discounts and a free initial consultation with all Network Providers. Please contact NVA for additional details at 877-295-8599.
Members are also eligible for a mail order contact lens replacement service, Contact Fill. Members can access Contact Fill’s services online at www.contactfill.com or by calling 866-234-1393.
Benefit Exclusions
Some services and materials are not covered under the Vision Benefit. The following is a partial list of what is not covered:
- Medical or surgical treatments
- Prescription Drugs or over-the-counter medications
- Non-prescription lenses
- Two pair of glasses in lieu of bifocals
- Subnormal visual aids
- Vision examinations or material 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, or 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
- Sunglasses
Contact NVA for additional details
Customer Service: 1-800-672-7723
Website: www.e-nva.comÂ
Find A Provider – Sponsor #: 1373100
For additional information, Members can review their Insurance Summary Plan Description.