Solstice Vision
(Available in all 50 states)
Competitive coverage that allows members access to an extensive network of vision providers for continued visual health. Plans provide coverage for exams, lenses, contact lenses, frames and even LASIK. The Difference is Clear.
| Provider Lookup (Davis Vision) | http://www.solsticebenefits.com/provider-search.aspx (Davis Vision) |
| Find a Dental Provider (How To) | |
| Plan Summary, Services & Co-pays | PDF |
| In Network Benefits | |
| Eye Examination inclusive of Dilation (when professionally indicated) | 12 Months |
| Spectacle Lenses | 12 Months |
| Frame | 24 months |
| Contact Lens Evaluation, Fitting & Follow Up Care | 12 Months |
| Contact Lenses (in lieu of eyeglasses) | 12 Months |
| Copayments | |
| Eye Examination | $10 |
| Spectacle Lenses | $25 |
| Contact Lens Evaluation, Fitting & FollowͲUp Care¹ | $25 |
| Eyeglass Benefit Frame (Average Retail Value) | |
| Non-Collection Frame Allowance (Retail): Up to $150 | Up to $100 Plus a 20% discount on any overage ² |
| Davis Vision Frame Collection³ (in lieu of Allowance): | |
| Fashion level Up to $125 | Included |
| Designer level Up to $175 | $15 copayment |
| Premier level Up to $225 | $40 copayment |
| Eyeglass Benefit Spectacle Lenses (Average Retail Value) | Member Charges |
| Clear plastic singleͲvision, lined bifocal, trifocal or lenticular lenses (any size or Rx) ($60 to $120) |
Included |
| Tinting of Plastic Lenses ($20) | $15 |
| Scratch Resistant Coating ($25-$40) | Included |
| Polycarbonate Lenses (Children/ Adults) ($60-$75) | $0 or $35 |
| Ultraviolet Coating ($25-$30) | $15 |
| Anti-Reflective (AR) Coating(Standard/Premium/Ultra) ($50-$125) | $40 / $55 / $69 |
| Progressive Lenses(Standard / Premium / Ultra) ($150-$300) | $65 / $105 / $140 |
| Intermediate-Vision Lenses ($150-$175) | $30 |
| High-Index Lenses ($90-$150) | $60 |
| Polarized Lenses ($95-$110) | $75 |
| Plastic Photosensitive Lenses ($95-150) | $70 |
| Scratch Protection Plan: Single Vision | Multifocal Lenses | $20/$40 |
| Contact Lens Benefit (in lieu of eyeglasses) | |
| Non-Collection Contact Lenses: Materials Allowance | Up to $100 Plus a 15% discount on any overage² |
| - Evaluation, Fitting & Follow-Up Care – Standard Lens Types | 15% Discount² |
| - Evaluation, Fitting & Follow-Up Care – Specialty Lens Types | 15% Discount |
| Collection Contact Lenses ³ (in lieu of Allowance): Materials | |
| - Disposable | N/A |
| - Planned Replacement | N/A |
| - Evaluation, Fitting & Follow-up Care | N/A |
| Medically Necessary Contact Lenses (with prior approval) - Materials, Evaluation, Fitting & Follow-Up Care |
Included |
| Out of Network Reimbursement Schedule | up to: |
| Eye Examination | $40 |
| Frame | $50 |
| Single Vision Lenses | $40 |
| Bifocal/Progressive Lenses | $60 |
| Trifocal Lenses | $80 |
| Lenticular Lenses | $100 |
| Elective Contact Lenses | $80 |
| Medically Necessary CL | $225 |
| ¹ Copayment applies to Collection Contact Lenses only. ² Additional discounts not applicable at Walmart or Sam's Club locations. ³ Collection is available at most participating independent provider offices.Collection is subject to change.Collection is inclusive of select torics and multifocals. Ϻ Polycarbonate lenses are covered in full for dependent children, monocular patients and patients with prescriptions +/Ͳ6.00 diopters or greater. Category includes digital freeͲform progressive lenses. Freque |
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