- SELECT PROVIDER and MAKE APPOINTMENT
Select a PVCS provider from our website or call us. Make your appointment and identify yourself as a plan member. The provider will verify eligibility and file your claim. See item 6 for services provided by out-of-network doctors.
- COVERED SERVICES
- Eye examinations:
Intermediate or comprehensive eye examinations are covered when needed – not limited to a specific number or frequency of visits. Plan pays for all costs of these services.
- Eyewear (Materials): 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.
- 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 contact lenses, and the wholesale cost of the materials.
- Contact lens replacements will not be assessed the service fees but will be charged wholesale cost of materials (contact lenses).
- Eyeglass repairs 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.
- WHOLESALE COST
Wholesale cost is defined as: a) the current catalog listed price in Frames magazine for eyeglass frames, b) local or customary wholesale laboratory posted rate sheet for eyeglass lenses and options, or c) manufacturers or distributors published wholesale per lens or per box price for contact lenses plus d) applicable shipping costs and sales tax rounded up to nearest $5.
- LIMITATIONS AND EXCLUSIONS
Limitations and exclusions are categorized here as medical eye care, premium services, luxury frames, premium lenses, and non-prescription eyewear.
- Medical eye care is defined and covered by most medical insurance plans. Your PVCS doctor can provide many of the services that fall into this category. Your doctor will file with your medical insurance carrier for reimbursement. If not covered by your medical insurance, you will be responsible for medical eye care payments to the doctor.
- Virtual exams
are not covered by this plan. All comprehensive and intermediate eye examinations must be performed in person by a licensed optometrist or ophthalmologist.
- 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 those tests and procedures published as standards by the State Board of Examiners in Optometry.
Orthokeratology (by whatever associated name) is not covered by this plan. Doctor will charge their 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 receive a 20% discount.
- Premium lenses are prescription lenses with a wholesale cost of more than $375 (not including tints and coatings). Premium lenses 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. Plan members 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. PVCS will not 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 member may seek services from a doctor of their choice. PVCS will reimburse the member a portion of the service fee incurred from a non-participating doctor meeting these criteria. The member must submit a paid itemized statement or receipt of the doctor’s charges directly to PVCS for reimbursement. This claim must be received by PVCS within 90 days of the claimed date of service.
- DISCOUNTED LASER REFRACTIVE SURGERY . PVCS offers its plan members the opportunity to obtain discounts on laser refractive surgery through nJoyVision in Oklahoma City and OMEG in Tulsa.
“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.”