LSU System Vision Plan

Employees may enroll during the first 30 days of employment and coverage is effective the first of the month following 30 days of employment.

After initial eligibility period, enrollment/cancellation of coverage is limited to the Annual Enrollment period in October with a January effective date.

Eligibility

Employees appointed to work a minimum of 30 hours (75%) or more per week are eligible to participate in the Vision Plan. Dependents are also eligible for coverage. Premiums are available for tax sheltering under the Cafeteria Plan. Once enrolled, coverage can only be canceled annually during the Open Enrollment period.

Services

The "Davis Vision" Plan pays for many routine vision care expenses. The program allows you to access benefits at a nationwide network including Wal-Mart vision centers, independent optometrists, and ophthalmologists, and retail chains such as Texas State Optical, Vision Optique, and America's Best.

Vision Benefit Summary

Vision Care Services	Non LSU First Health Plan Members Using In-Network	LSU First Health Plan Members Using In-Network Provider
Exam Once per plan year (Jan. 1 - Dec. 31) Includes dilation when professionally indicated.	$10 Co-pay	No co-pay
Materials Once per plan year (Jan. 1 - Dec. 31)	$0	$0
Standard Plastic Lenses:
Single Vision	$0	$0
Bifocal	$0	$0
Trifocal	$0	$0
Lenticular	$0	$0
Oversized Lenses	$0	$0
Tinted Lenses	$0	$0
Standard Progressive	$50	$0
Premium Progressive	$90	$0
Photochromatic Glass Lenses	$20	$20
Plastic Photosensitive Lenses	$65	$65
Hi-index (thinner & lighter)	$55	$55


Lens Options:
Scratch Resistant Coating	$0	$0
Polycarbonate for children	Included	Included
Polycarbonate for adult	$30	$30
UV Coating	$12	$0
Scratch Protection Plan	$20/$40	$0
Standard Anti-reflective Coating	$35	$35
Premium AR Coating	$48	$48
Ultra AR Coating	$60	$60
Intermediate Vision Lenses	$30	$30
Blended Invisible Lenses	$20	$20
Polarized Lenses	$75	$75
Frames: Once per plan year (Jan. 1 - Dec. 31)	Choose from Davis Vision Designer Frame Collection (retail value of $125 - $175) OR $100 allowance + 20% off any overage toward retail cost of any other frame	Choose from Davis Vision Designer Frame Collection (retail value of $125 - $175) OR $130 allowance + 20% off any overage toward retail cost of any other frame
Contact Lenses (In Lieu of glasses) Once per plan year (Jan. 1 - Dec. 31)


Elective lenses (formulary)	Up to 4 boxes of disposables	Up to 4 boxes of disposables

Elective contacts (non-formulary)	Up to $130 + 15% discount off overage	Up to $130 + 15% discount off overage

Medically Necessary Lenses	Paid in Full with Prior Approval	Paid in Full with Prior Approval

Contact Fitting Fee Included in Allowance	Covered in Full for Formulary Contacts 15% discount for Non-Formulary Contacts	Covered in Full for Formulary Contacts 15% discount for Non-Formulary Contacts

Discount on Additional or Replacement Contact Lenses	Enrolled in LENS 1-2-3 Mail Order Program guarantees the lowest price on Contact Lenses	Enrolled in LENS 1-2-3 Mail Order Program guarantees the lowest price on Contact Lenses
Lasik or PRK	Up to 25% discount or $5 off any special	Up to 25% discount or $5 off any special
Low Vision	1 comprehensive Low-Vision Exam every 5 years: Low Vision allowance of $600 with a lifetime maximum of $1200; Follow-up care of 4 visits in a 5 year period	1 comprehensive Low-Vision Exam every 5 years: Low Vision allowance of $600 with a lifetime maximum of $1200; Follow-up care of 4 visits in a 5 year period
Warranty on Frames/Lens	1 year unconditional breakage warranty on any Davis Vision Collection Frame or any frame purchased from Wal-Mart or EyeMasters	1 year unconditional breakage warranty on any Davis Vision Collection Frame or any frame purchased from Wal-Mart or EyeMasters
When purchasing both Contacts and Spectacle is a fee a flat amount or discounted amount off retail?	Discount off retail on second materials	Discount off retail on second materials

Frequency

Examination	Once every 12 months
Spectacle Lenses	Once every 12 months
Frames	Once every 12 months
Contact Lenses	Once every 12 months

Premiums

Premiums	Bi-Weekly	Monthly
Employee Only	$3.83	$7.66
Employee & Spouse	$6.45	$12.90
Employee & Children	$6.59	$13.18
Family	$10.62	$21.24

To find a provider, members can visit www.davisvision.com or call 1-888-7778-7183.

For more information on the plan and its limitations and exclusions or the enrollment, please click here.