Frequently Asked Questions about
Vision Care Coverage
- What vision services are covered under the Vision Care plan?
- How does Vision Care coverage work?
- What are the advantages of using in-network vision providers?
- How do my clients find an in-network provider?
- Does Vision Care cover Lasik?
- Will my clients get a separate member ID card for Vision Care?
- What if I have questions about vision 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 your clients choose – Premier or Preferred – they will make copayments or receive discounts off these services. Also, these services may be available to your clients once every 12 or 24 months, or the frequency may be unlimited. For benefit details, your clients can check their Vision Care Rider. The Vision Care benefits are provided through a contractual agreement with Davis Vision*. If your clients are planning to obtain services under Vision Care and want the services to be covered at the highest benefit level, they need to select a participating vision provider who is contracted with the Davis Vision Network.
Please note that benefits with your clients Vision Care Rider are separate and in addition to any vision coverage that is offered by their Blue Cross and Blue Shield of New Mexico (BCBSNM) medical plan. For example, the medical plan covers vision screening for members through age 17, 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, your clients need to follow the medical plan guidelines and use the participating providers for their specific plan (e.g., PPO, HMO, etc.). For more information, your clients can check their medical plan Benefit Booklet or call Customer Service using the phone number on the back of their member ID card.
How does Vision Care coverage work?
Your clients make an appointment with the provider of their choice. At the doctor's office, they present their BCBSNM member ID card. They will pay a copayment for a vision exam from an in-network provider. For a vision exam from an out-of-network provider, they 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; your clients 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), they will 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, they 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.
What are the advantages of using in-network vision providers?
Davis Vision has over 20,000 providers nationwide. The network includes EyeMasters® and many independent ophthalmologists, optometrists, and opticians. Your clients will have greater coverage and pay less out of their pocket when they use Davis Vision providers. For most services, they will pay a copayment or pay the discounted amount for services or materials. If they use an out-of-network provider, some of the services are not covered. For covered services from an out-of-network provider, they will need to pay the full amount out of their 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 your clients to ask if their provider participates with the Davis Vision network and let them know they are a BCBSNM member.
How do my clients find an in-network provider?
Your clients can search the Provider Finder® for an in-network Davis Vision provider in New Mexico. They may also call Davis Vision toll-free at 1-877-393-2393 to find participating providers.
Does Vision Care cover Lasik?
Yes, the 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, your clients can call 1-877-393-2393.
Will my clients get a separate member ID card for Vision Care?
No. They simply use the member ID card issued for their BCBSNM medical plan. Their vision provider will need the identification number on their member ID card and can contact Davis Vision to verify eligibility and benefits on their behalf.
What if I have questions about vision coverage?
For more information about covered vision services, in-network providers, or benefits, 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.
* 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.
Learn More About Preferred and Premier Vision Care Plans:
