Attachment_B6__Vision_Plan_Summary(6008303.1).pdf
PDF 319 KB Posted
- Attached to
- Employee Benefits-Dental and Vision
- Solicitation number
- 27-010CH-32RFP
- Issued by
- Maricopa County, Tucson City, Arizona
About this file
This is a Vision Plan Summary document for the Tempe Union High School District, which outlines the Davis Vision voluntary vision benefit plan effective July 1, 2026. The document details comprehensive vision coverage including routine eye examinations, spectacle lenses, frames, contact lens evaluations and fittings, and contact lenses as alternatives to eyeglasses. The plan operates on a 12-month benefit frequency for most services, with members accessing in-network providers through Davis Vision's network or seeking out-of-network care with subsequent reimbursement. The District intends to continue offering this Davis Vision plan design, along with voluntary dental plans (Cigna DHMO and Delta Dental PPO), through the plan year July 1, 2027 to June 30, 2032, with proposals due by 2:00 pm on November 4, 2026, submitted through the Procurement Portal at https://procurement.opengov.com/portal/tuhsd.
The Davis Vision Fashion Plan provides in-network benefits with minimal copayments, including a $10 copay for eye examinations and spectacle lenses, no copay for frames with coverage up to $100 for Davis Vision Collection frames or $150 at Visionworks locations with additional discounts on frame balance, and no copay for contact lens evaluation and fitting. Out-of-network reimbursement limits are established at $40 for eye exams, $40-$100 for lenses depending on type, $50 for frames, and $80-$225 for contact lenses. The plan includes additional benefits such as a one-year breakage warranty, laser vision correction discounts, low vision services, and various lens options and coatings available at member prices ranging from no charge to $175 for premium progressive lenses. Members access the plan by contacting Davis Vision at 1.800.999.5431 or visiting davisvision.com with client code 8094, with the plan underwritten by HM Life Insurance Company and administered by Davis Vision.
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Text version
Welcome to Davis Vision!
We are pleased to provide you with information on your vision benefit to help you care for your vision and eye health - a key part of overall health and wellness!
If you are not currently enrolled, please visit our member site at davisvision.com or call 1.877.923.2847 and enter client code 8094 to locate providers or for additional information.
7/1/2026
SPCVX01109web 2/24/25
Tempe Union High School District
Using your benefits is easy! Just log on to our Member site at davisvision.com and click “Find a Provider,” or call us at 1.800.999.5431.
Make an appointment. Tell your provider you are a Davis Vision member with coverage through Tempe Union High School District. Provide your member ID number, name and date of birth, and do the same for your covered dependents seeking vision services. Your provider will take care of the rest!
Your Davis Vision Fashion Plan Benefits
1/ Some limitations apply to additional discounts, discounts not applicable at all in-network providers.
2/ The Davis Vision Collection is available at most participating independent provider locations. Collection is subject to change. Collection is inclusive of select toric and multifocal contacts.
3/ Including, but not limited to toric, multifocal and gas permeable contact lenses.
4/ For dependent children, monocular patients and patients with prescriptions of
+/- 6.00 diopters or greater.
5/ Enhanced frame allowance available at all Visionworks Locations nationwide Ex-cludes Maui Jim eyewear.
6/ Transitions® is a registered trademark of Transitions Optical Inc.
Please note: Your provider reserves the right to not dispense materials until all applicable member costs, fees and copayments have been collected. Contact lenses: Routine eye examinations do not include professional services for contact lens evaluations. Any applicable fees above the evaluation and fitting allowance are the responsibility of the member. If contact lenses are selected and fitted, they may not be exchanged for eyeglasses. Progressive lenses: If you are unable to adapt to progressive addition lenses you have purchased, conventional bifocals will be supplied at no additional cost; however, your copayment is nonrefundable.
May not be combined with other discounts or offers. Please be advised these lens options and copayments apply to in-network benefits.
Significant savings on optional frames, lens types and coatings! Member Price Davis Vision Collection Frames: Fashion | Designer | Premier.................................$0 | $15 | $40 Tinting of Plastic Lenses............................................................................................................ $15 Oversize Lenses.......................................................................................................................... $0 Scratch-Resistant Coating........................................................................................................... $0 Premium Scratch-Resistant Coating......................................................................................... $30 Ultraviolet Coating..................................................................................................................... $15 Anti-Reflective Coating: Standard | Premium | Ultra | Ultimate......................$40 | $55 | $69 | $85 Polycarbonate Lenses ....................................................................................................... $0/4-$35 High-Index Lenses: 1.67 | 1.74 ..................................................................................... $60 | $120 Progressive Lenses: Standard | Premium | Ultra | Ultimate.....................$65 | $105 | $140 | $175 Polarized Lenses ...................................................................................................................... $75 Photochromic Lenses (i.e. Transitions®, etc.)/6 ......................................................................... $70 Scratch Protection Plan: Single Vision | Multifocal Lenses.............................................. $20 | $40 Trivex Lenses............................................................................................................................ $50 Blue Light Filtering..................................................................................................................... $15
Benefit Frequency Once every -
In-network Copay
In-network Coverage
Eye Examination 12 months $10 Covered in full. Includes dilation when professionally indicated.
Spectacle Lenses 12 months $10 Clear plastic lenses in any single vision, bifocal, trifocal or lenticular prescription. Covered in full.
(See below for additional lens options and coatings.)
Frame 12 months $0
Covered in Full Frames:
OR, Frame Allowance:
OR, Visionworks Frame Allowance:
Any Fashion level frame from Davis Vision’s Collection/2 (retail value, up to $100).
$100 toward any frame from provider plus 20% off any balance./1 No copay required.
$150 allowance plus 20% off any balance toward any frame from a Visionworks family of store locations./5
No copay required.
Contact Lens Evaluation, Fitting & Follow Up Care
12 months $0 Standard, Soft Contacts:
Specialty Contacts/3:
15% discount/1
15% discount/1
Contact Lenses (in lieu of eyeglasses)
12 months $0
Contact Lens Allowance:
OR, Visually Required Contacts:
$110 allowance toward any contacts from provider’s supply plus 15% off balance./1 No copay required.
Covered in full with prior approval.
Frequently Asked Questions How can I contact Member Services?
Call 1.800.999.5431 for automated help 24/7.
(TTY services: 1.800.523.2847.)
What frames are in Davis Vision’s Collection?
Our Collection offers a great selection of fashionable and designer frames, most of which are covered in full after your copay. No wonder 8 out of 10 members select a Collection frame. Log on to our member Web site at davisvision.com and take a look!
When will I receive my eyewear?
Your eyewear will be delivered to your network provider generally within five business days of order receipt. Special prescriptions, lens coatings, provider frames or out-of-stock frames may delay the standard turnaround time.
Do I need a claim form?
Claim forms are only required if you visit an out-of-network provider. Claim forms are available on our member Web site.
Can I split my benefits?
You may split your benefits by receiving your eye examination and eyeglasses or contact lenses on different dates or through different provider locations. Complete eyeglasses must be obtained at one time, from one provider. You may not split between a network and out-of-network provider. To maximize your benefit value we recommend that all services be obtained from a network provider.
Can I use an out-of-network provider?
Yes; however, you receive the greatest value by staying in-network.
If you go out-of-network, pay the provider at the time of service, then submit a claim to Davis Vision for reimbursement, up to the following amounts: eye exam - $40 | single vision lenses - $40 | bifocal - $60 | trifocal - $80 | lenticular - $100 | frame - $50 | elective contacts - $80 | visually required contacts - $225.
Are there any exclusions to the vision benefits?
Your vision plan does not cover medical treatment of eye disease or injury; vision therapy; special lens designs or coatings, other than those described herein; replacement of lost eyewear; non-prescription (plano) lenses; contact lenses and eyeglasses in the same benefit cycle; services not performed by licensed personnel;
two pair of eyeglasses in lieu of bifocals.
DAVIS VISION EXTRAS!
One Year Breakage Warranty Repair or replacement of your plan covered spectacle lenses, Collection frame or frame from a network retail location where the Collection is not displayed.
Greater Benefits Access a higher frame allowance by visiting a Visionworks family of store locations./7
Additional Savings Members will receive 50% off of additional complete pairs of eyeglasses and sunglasses at Visionworks and 30% off at other participating providers on the same transaction.
Otherwise, a 20% discount off the provider’s usual and customary rate is available. Contact lenses are available at a 10% discount./8
Laser Vision Correction Davis Vision provides you and your eligible dependents with the opportunity to receive discounted laser vision correction, often referred to as LASIK. For more information, visit www.davisvision.com.
Low Vision Services Comprehensive low vision evaluation once every five years and low vision aids up to the plan maximum.
Covers up to four follow-up visits in five years.
Eye Health & Wellness Log on and learn more about your eyes, health and wellness; common eye conditions that can impair vision; and what you can do to ensure healthy eyes and a healthier life.
For more details… about your vision benefits, patient rights and responsibilities, or more information about Davis Vision, please log on to our member Web site or contact us at 1.800.999.5431.
Davis Vision has made every effort to correctly summarize your vision plan features herein. In the event of a conflict between this information and your organization’s contract with Davis Vision, the terms of the contract will prevail.
Fully insured product Underwritten by HM Life Insurance Company. Administered by Davis Vision, which may operate as Davis Vision Insurance Administrators in California.
7/ Enhanced frame allowance available at all Visionworks Locations nationwide Excludes Maui Jim eyewear.
8/Some limitations apply to additional discounts, discounts not applicable at all in-network providers.
File details come from the government source that posted it. Updated .