Primary Vision Care Services
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Plan and Benefits
No Paperwork Required!
You need only to make your own appointment with your preferred panel doctor. Required Plan paperwork is completed by your panel doctor. See item 6 for services provided by non-panel doctors.
, whether intermediate or comprehensive, are covered when needed – not limited to a specific number or frequency of visits. Plan pays for all costs of these services.
There is no limit to the number of pairs of prescriptive eyeglasses. Contact Lenses are limited to annual supplies.
Both are available simultaneously in this plan.
All materials are offered at wholesale cost.
Plan pays for all service fees for eyeglass fittings. You will be required to pay the "wholesale cost" of the materials (frames and/or lenses) for any eyeglasses ordered. There is no limit to the number of pairs of eyeglasses you may order.
Contact lens fittings:
Original (first time) contact lens fittings and contact lens refittings (change in lens parameters) are covered for a $50.00 service fee on soft contacts; a $75.00 service fee on rigid contacts; and a $150.00 service fee on hybrid contact lenses, including Synergeyes and Softperm contact lenses, and the "wholesale cost" of the materials.
Contact lens replacements
be assessed the service fees, but will be charged "wholesale cost" of materials (contact lenses).
are performed at no charge unless a cost to the doctor is incurred for replacing a frame part or lens. Patient will be required to pay such cost if incurred.
is defined as a) the current catalog listed price in
magazine for eyeglass frames, b) local or customary wholesale laboratory posted rate sheet for eyeglass lenses and options,
c) manufacturers or distributor’s published wholesale per-lens or per-case price for contact lenses
d) applicable shipping costs and sales tax rounded up to the nearest $5.00.
Limitations and Exclusions
, categorized here as medical eye care, premium services, and luxury frames.
Medical eye care is defined and covered by most medical benefit plans. Your PVCS doctor can provide many of the services that fall into this category. Your doctor will file with your medical benefit carrier for reimbursement. If not covered by your medical benefit, you will be responsible for medical eye care payments to the doctor.
Premium services are not covered by this plan. Premium services include non-routine vision services such as vision therapy, laser treatments or refractive surgery, other forms of ophthalmic surgery, photography, corneal topography, orthokeratology, dispensing prescription or non-prescription medications, and technological
advancements unknown or not customary and routine at the inception of this contract. Customary and routine services are considered to be those tests and procedures published as standards by the State Board of Examiners in Optometry.
Note: Orthokeratology (by whatever associated name)
is not covered
by this plan. Doctor will charge his usual and customary fee, less PVCS reimbursement for a routine eye exam and contact lens fitting.
Luxury frames are frames with a "wholesale cost" of more than $125. Luxury frames will receive a 20% discount.
Premium lenses are prescription lenses with a "wholesale cost" or more than $300.00 (not including tints and coatings). Premium lenses will receive a 20% discount.
Non-prescription eyewear (sun or safety glasses) is not covered by this plan.
PVCS Participating Doctors:
An extensive, quality panel of independent optometrists has been assembled to provide service under this plan. Use of these doctors is mandatory and necessary to receive full plan services under these special pricing arrangements. Enrollees who wish to have a non-participating doctor added to the panel are encouraged to have the doctor contact PVCS. PVCS retains the right to determine which doctors are added to the Plan.
Use of Non-Participating Doctors:
Inside the State of Oklahoma
reimburse the plan member for services obtained within the State of Oklahoma from a non-participating doctor.
Outside the State of Oklahoma
. Plan members must use a participating doctor if one is available within 30 miles of their residence or place of work. If a participating doctor is not available within this distance, the plan member may seek services from a doctor of his choice. PVCS
reimburse the plan member a portion of the service fee incurred from a non-participating doctor meeting this criterion. The employee must submit an itemized statement of the Doctor’s charges directly to PVCS for reimbursement. This claim must received by PVCS within 90 days of the claimed date of service.
Discounted Laser Refractive Surgery
. PVCS also offers its plan members the opportunity to obtain discounts on laser refractive surgery through a number of quality and reputable laser centers located in Oklahoma and nationally. Call PVCS for the name of the participating laser refractive surgical centers and for current fees.
Terms of Service
Individual Terms of Service
"The service provided herein is not insurance. State insurance insolvency guarantee funds are not available for your use in the event of insolvency or liquidation of this company"
The PVCS plan is considered to be a Direct Care Plan by the Oklahoma Insurance Department and is governed by the Department pursuant to 36 O.S. Section 632.