- 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 providers.
- 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 prescription glasses. 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 provider 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.
- EXCLUSIONS AND LIMITATIONS
Exclusions and limitations are categorized here as medical eye care, virtual exams, premium services, non-prescriptive eyewear, luxury frames, and premium lenses.
- Medical eye care is defined and covered by most medical insurance plans. Your PVCS provider can provide many of the services that fall into this category and 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 provider.
- 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.
- *Note: Orthokeratology (by whatever associated name) is not covered by this plan. Provider will charge their usual and customary fee, less PVCS reimbursement for a routine eye exam and contact lens fitting.
- Non-prescription eyewear is not covered by this plan. (Sun or safety glasses)
- 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.
- PVCS PARTICIPATING PROVIDERS
A quality panel of independent optometrists and ophthalmologists have been assembled to provide service under this plan. Use of these providers is mandatory and necessary to receive full plan services under these special pricing arrangements. Plan members who wish to have a non-participating provider added to the panel are encouraged to have the provider contact PVCS.
- USE OF NON-PARTICIPATING PROVIDERS
PVCS members are eligible for either in or out of network benefits each plan year. Out of network benefits are available in lieu of network benefits. Members are responsible for all charges up front and are required to submit a copy of the paid itemized receipt. Out of network limited to one exam and one pair of prescription glasses or contact lens supply per plan year. Maximum out of network reimbursements are $40 towards an exam and up to $60 for prescription glasses or contacts. PVCS recommends in network services to maximize benefits and savings.
- 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."