Retiree Vision Plan
Overview  |  Dental Plan  |  Vision Plan

Benefits are available at Davis Vision authorized vision providers a combination made up of independent opticians, MDs and retail locations to include: Wal-Mart Vision Centers Statewide.




Rates

Monthly Bank Draft

Annual Pay
Single: $ 7.98 $ 91.00
Employee+ One: $ 14.44 $ 165.00
Family: $ 21.58 $ 246.00
Type
Eye Examinations
Eyeglasses
Contact Lenses

Type
Eye Examinations
Eyeglasses
Contact Lenses



 Co-pay
$10
$25
$25

Months
12
24
12
Enrollment Instructions  |  Vision Application Detail Plan Information
• $10 copay for exams that include fundus dilation
• $25 Co-pay for the Davis Exclusive Frame Collection materials up to a $175 value
• $130 retail frame allowance for Non-Davis Vision materials
• Fixed copay Contact lens formulary
• Fixed copays for cosmetic options
• Out of network Reimbursement