Blue Access for Employers

Frequently Asked Questions About Vision Care Coverage



What vision services are covered under the Vision Care plan?

Vision Care coverage provides benefits for eye exams, a wide range of name brand and fashion frames and lenses, many different contact lens options, and discounts on laser vision correction. Depending on the Vision Care plan you choose for your employees – Premier or Preferred – they will make copayments or receive discounts off these services. Also, these services may be available to members once every 12 or 24 months, or the frequency may be unlimited. For benefit details, check the Vision Care Rider. Vision Care benefits are provided through a contractual agreement with Davis Vision*. If you or your employees plan to obtain services under Vision Care and want the services to be covered at the highest benefit level, you'll need to select a participating vision provider who is contracted with the Davis Vision network.

Please note that benefits with the Vision Care Rider are separate and in addition to any vision coverage that is offered by your Blue Cross and Blue Shield of New Mexico (BCBSNM) medical plan. For example, the medical plan covers vision screening for members, and it covers disease or injury to the eye for members of any age. The medical plan also provides for certain vision-related services for diabetic members. For vision services covered by the medical plan, please follow the medical plan guidelines and use the participating providers for your specific plan (e.g., PPO, HMO, etc.). For more information, members need to see the medical plan Benefit Booklet or call Customer Service using the phone number on the back of their member ID card.

* Blue Cross and Blue Shield of New Mexico vision coverage is administered through a contractual agreement with Davis Vision. The relationship between Blue Cross and Blue Shield of New Mexico and Davis Vision is solely that of independent contractors.

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How does Vision Care coverage work?

Your employees make an appointment with the provider of their choice. At the doctor's office, they need to present their BCBSNM member ID card. Members will pay a copayment for a vision exam from an in-network provider. For a vision exam from an out-of-network provider, members will pay a portion and the Vision Care Plan will pay the rest. Out-of-network providers may request payment in full at time of service; the member will need to submit a claim to Davis Vision for reimbursement. See the Summary of Benefits for the amounts that members pay.

For glasses (frames and spectacle lenses), members receive a discount off the retail price under the Preferred Plan; they will be responsible for copayment(s) for spectacle lenses and frames under the Premier Plan. For contact lenses, members will pay a percentage off the retail cost depending on the plan. Some services or types of materials are not covered if they are received from an out-of-network provider. See the Vision Care Rider for more information.

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What are the advantages of using Davis Vision in-network vision providers?

Davis Vision has over 20,000 providers nationwide. The network includes EyeMasters® and many independent ophthalmologists, optometrists, and opticians. Members have greater coverage and pay less out of pocket when using Davis Vision providers. For most services, members will pay a copayment or pay the discounted amount for services or materials. If members use an out-of-network provider, some of the services are not covered. For covered services from an out-of-network provider, members will need to pay the full amount out of pocket and file a claim with Davis Vision for reimbursement of the covered amount. Note: To ensure vision services are covered, it is important for members to ask if the provider participates with the Davis Vision network and let them know they are a BCBSNM member.

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How do my employees find an in-network provider?

Search  for an in-network Davis Vision provider in New Mexico. Members may also call Davis Vision toll-free at 1-877-393-2393 to find participating providers.

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Does Vision Care cover Lasik?

Yes, Vision Care plans provide a discount off the retail cost of Lasik or PRK. There is no coverage for Lasik if received from an out-of-network provider. To find a participating Lasik provider, call 1-877-393-2393.

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Will my employees get a separate member ID card for Vision Care?

No. Members simply use the member ID card issued for their BCBSNM medical plan. Their vision provider will need the identification number on the member ID card and can contact Davis Vision to verify eligibility and benefits on their behalf.

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What if my employees have questions about their vision coverage?

For more information about covered vision services, in-network providers, or benefits, members can call the vision claims administrator (Davis Vision) toll-free at 1-877-393-2393 Monday through Friday 6 a.m. to 9 p.m., Saturday 7 a.m. to 2 p.m., and Sunday 10 a.m. to 2 p.m. Mountain Time.

For information on health care benefits, enrollment, termination, and eligibility questions, members can call the customer service number on the back of their BCBSNM member ID card.

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Learn More About Preferred and Premier Vision Care

Overview
Benefit Information

 

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