Plan Benefits

Benefit In-network benefit Out-of-network reimbursement
Exam (once every calendar year) $0 copay Up to $50 reimbursed
Frames (once every calendar year)
Provider offering Davis Vision Exclusive Collection of Frames3
Fashion tier
Designer tier
Premier tier		 $0 copay
$0 copay
$0 copay		 N/A
Visionworks Retail locations Allowance of up to $2001 toward frames, plus 20% off any overage2 N/A
Other eye care professionals Allowance of up to $1501 toward frames, plus 20% off any overage2 Up to $50 reimbursed
Lenses (once every calendar year)
Lenses
Single, bifocal, trifocal, lenticular		 $20 copay $40 - $100 reimbursed
Lens extras
Tinting, scratch-resistant coating, kids' polycarbonate, oversize lenses		 $0 copay $40 - $100 reimbursed
Additional lens extras
Progressives, anti-reflective, UV, scratch coatings		 Fixed member charges listed in below chart $40 - $100 reimbursed
Contact lenses - in lieu of eyeglasses (once every calendar year)
Contacts from the Davis Vision Exclusive Collection of Contact Lenses3
Disposable
Planned replacement		 $0 copay – 4 boxes maximum
$0 copay – 2 boxes maximum		 N/A
Non-collection contacts (from provider supply)
Visionworks (in-network)
Other eye care professionals (in-network or out-of-network)		 Allowance of up to $1501 toward Contacts, plus 15% off any coverage² Up to $150 reimbursed
Contact lens fitting fee    
Davis Vision Exclusive Collection only3 $20 copay
 N/A
Standard and specialty 15% discount2 Up to $150 reimbursed (includes exam and boxes of contacts)

 

1. Allowance must be used in full at time of purchase.
2. Additional discounts not applicable at Walmart, Sam's Club, or Costco locations or where limited by law or manufacturer restrictions.
3. Exclusive Collection is available at most participating independent provider offices. Exclusive Collectionis subject to change. Exclusive Collection is inclusive of select topics and multifocal.
* If plan differences exist between this document and the contract, the contract will prevail.

Additional lens extras: Lens options and coatings  Member cost
Plastic lenses (all ranges of prescriptions/sizes) Covered
Oversized lenses Covered
Tinting of plastic lenses Covered
Scratch-resistant coating Covered
Polycarbonate lenses for children $0
Polycarbonate lenses for adults $30
Ultraviolet coating $12
Standard anti-reflective ( AR ) coating $35
Premium AR coating $48
Ultra-AR coating $60
Ultimate AR Coating $85
Standard progressive $50
Premium progressives ( various®,etc.) $90
Ultra-progressives ( digital, freeform styles ) $140
Ultimate Progressives $175
High-index lenses 1.67 $55
High-index lenses 1.74 $120
Polarized lenses $75
Photochromic lenses ( Transition® Signature™) $65
Scratch protection plan (single vision / multifocal) $20/$40

Laser Surgery Benefit (in-network or out-of-network)

(Additional discounts available through QualSight)

$500 Lifetime Reimbursement

per member, in-network or out-of-network

ADDITIONAL OPTIONS!

One-year Breakage Warranty Our exclusive Breakage Warranty provides repair or replacement within one year of your Davis Vision Exclusive Collection frames and lenses, or frames and lenses from a Vision works location.

Additional Savings Members will receive 50% off additional complete pairs of eyeglasses and sunglasses at Vision works and 30% off at other participating providers on the same transaction once the plan benefit is exhausted. Otherwise, a 20% discount off the provider’s usual and customary rate is available. Contact lenses are available at a 10% discount¹ at independent eye care professional offices and Vision works locations.

Laser Vision Correction (Often referred to as LASIK) Davis Vision provides you and your eligible dependents with the opportunity to receive discounted laser vision correction, available through QualSight. For more information visit www.davisvision.com/cornell. An additional lifetime reimbursement of $500 is available per member.

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.

Hearing Aids Visit www.davisvision.yourhearing.com, or call 1 (888) 809-0044 to find out about discounts on hearing exams and hearing aids.

For more details… Regarding your vision benefits, patient rights and responsibilities, or more information about Davis Vision, log on to www.davisvision.com/cornell or call 1 (877) 923-2847, and use client code 9092 prior to enrollment.

 

MetLife vision benefits are underwritten by Metropolitan Life Insurance Company, New York, NY. Certain claims and network administration services are provided through Davis Vision, Inc. (“Davis Vision”), a New York corporation. Davis Vision is part of the MetLife family of companies. Like most group benefit programs, Davis Vision by MetLife plans contain certain exclusions, exceptions, reductions, limitations, waiting periods and terms for keeping them in force. Please contact MetLife or your plan administrator for costs and complete details.