2019 vision guide€¦ · contact lens beneﬁt (in lieu of eyeglasses) contact lenses: materials...

HorizonBlue.com/vision

2019 Vision GuideFor Groups with 51 or More Employees

Effective 7/1/19 – 12/31/19

They’re frustrated with deceptive prices and baffling terms and conditions. As they struggle to comprehendtheir vision benefit, they question why buying a pair of glasses is so difficult. And yet, most people rely onsome form of vision correction – 75 percent of Americans require glasses or contact lenses.

Horizon Vision is more than a retailer or plan administrator. We differentiate ourselves in the vision care industryby providing the best value to our customers through our commitment to transparency, accessibility andsimplicity. We know that getting vision care isn’t just about finding the lowest cost for a new pair of glasses. Eye exams also can detect diseases like glaucoma, diabetes and hypertension. Horizon Vision can help youremployees get the care they need when they need it.

An investment that pays offEnrolling in a Horizon Vision plan is a sensible and prudent decision. We offer a variety of plans that cover eyeexams and materials, and we use aggregated member data to show you how certain chronic health conditionscorrelate with medical expenses and wellness – and why it pays to combine coverage from one carrier.

Since 1932, Horizon Blue CrossBlue Shield of New Jersey hasbeen providing protection andpeace of mind to our customers.And we look forward to doing thesame for your employees.

Our Promise• To serve with excellence and dedication• To provide peace of mind for those who depend

on us• To enrich the lives and health of our members

and the communities we serve

Why Horizon Vision?

For far too many people, taking care of their eyes has becomecomplicated and expensive.

Each plan is designed to have hundreds of frame and lens options at fixed member pricing so members canget the look they want at low prices. Plus, when members purchase frames through Visionworks®, they’llreceive an additional $50 allowance above the plan benefit. Visionworks carries an array of designer andexclusive brands, so members can save money without sacrificing quality.

All Horizon Vision plans offer:• An annual eye exam, including dilation• Coverage for eyeglasses and contact lenses• A higher frame allowance when purchased through Visionworks• A one-year breakage warranty

LASIK DiscountsHorizon Vision members enjoy lower prices on LASIK procedures than those offered by other carriers, along with flexible financing options – up to 12 months interest free. Horizon Vision members can save 40 to 50 percent off the national average for traditional LASIK at one of the more than 1,000 locations across our nationwide network of laser vision correction providers.1

1 Laser vision correction services are administered by QualSight, LLC. Terms and conditions are subject to change.

All Horizon Vision plans provide members with high-quality productsand services with little to no out-of-pocket cost.

Why Horizon Vision?

All Horizon Vision plans use Davis Vision’s core nationwide network of independent retailers and Visionworkslocations. These nearly 45,000 points of access make up the Horizon/Davis Vision Select network.1

Many of our plans, however, leverage the expanded Horizon/Davis Vision View network, which contains anadditional 25,000 eye care professionals throughout the country.1

The chart below indicates the network associated with each plan. The plan summaries on the following pagesalso indicate the associated network.

Members can locate in-network vision providers on Horizon BCBSNJ’s Online Doctor & Hospital Finder atHorizonBlue.com/doctorfinder. In the Quick Links below the tool is a Horizon Vision link that directsmembers to a vision provider search.

Plan Horizon/Davis Vision Select Network

Horizon/Davis Vision View Network

Horizon Vista I 3Horizon Vista II 3Horizon Vista III 3Horizon Vista IV 3Horizon Panorama IIIA 3Horizon Panorama IIIB 3Horizon Panorama IVA 3Horizon Panorama IVB 3Horizon Expanse V 3Horizon Expanse VI 3Horizon Expanse VIIA 3Horizon Expanse VIIB 3Horizon Expanse VIII 3

1 Network counts are based on data as of January 2017 and are subject to change.

Our Networks

Plans available to our Large Group customers are outlined on the following pages. Please keep the following1

in mind when choosing a vision plan for your benefits offering:

• Large employers may select one of the following employer contribution levels:

Employer paid (Funded): Employer pays greater than or equal to 75 percent of premium across all contract types.

Employee paid (Voluntary): Employer pays less than 75 percent of premium across all contract types.

• A Horizon Vision plan may be purchased without a medical plan:

As a funded plan if the group has 500-plus eligible employees

As a voluntary plan if the group has 1,000-plus eligible employees

• There is no minimum participation requirement.

• Rates may be guaranteed for up to three years.

• One Horizon Vision plan offering is standard. Two offerings are available to groups with 500-plus eligible employees.

1 Additional underwriting assumptions may apply.

Large Group Employer Rules

1 Members receive an additional $50 allowance at Visionworks retail locations.2 Additional discounts not applicable at Walmart, Sam’s Club or Costco locations.3 Davis Vision Collection is available at most participating independent provider offices. Frame collection is subject to change. 4 Polycarbonate lenses are covered in full for dependent children, monocular patients and patients with prescriptions +/- 6.00 diopters or greater.

Horizon Vista I (Horizon/Davis Vision View Network)

Horizon Vista I

Once every:

Eye examination including dilation (when professionally indicated) 12 months

Spectacle lenses 12 months

Frame 12 months

Contact lens evaluation, fitting and follow-up care 12 months

Contact lenses (in lieu of eyeglasses) 12 months

Copayments

Eye examination $0

Spectacle lenses $10

Eyeglass Benefit –– Frame Member charges

Non-collection frame allowance (retail)Up to $100 or $1501

plus a 20% discount on any overage2

Davis Vision Frame Collection3 (in lieu of allowance): Fashion level / Designer level / Premier level Included / $15 / $40

Eyeglass Benefit –– Spectacle Lenses

Clear plastic single-vision, lined bifocal, trifocal or lenticular lenses (any size or Rx) Included

Oversize lenses Included

Tinting of plastic lenses $15

Scratch-resistant coating Included

Polycarbonate lenses4 $0 or $35

Ultraviolet coating $15

Anti-reflective (AR) coating (standard / premium / ultra) $40 / $55 / $69

Progressive lenses (standard / premium / ultra) $65 / $105 / $140

High-index lenses $60

Intermediate-vision lenses $30

Polarized lenses $75

Plastic photochromic lenses $70

Scratch Protection Plan: Single vision / Multifocal lenses $20 / $40

Contact Lens Benefit (in lieu of eyeglasses)

Contact lenses: Materials allowanceUp to $100

plus a 15% discount2 on any overage

Evaluation, fitting and follow-up care –– standard and specialty lens types 15% discount2

Medically required contact lenses (with prior approval)Materials, evaluation, fitting and follow-up care

Included

Effective 7/1/19-12/31/19

Horizon Vista II

Once every:



Frame 24 months



CopaymentsEye examination $10



Non-Collection frame allowance (retail) Up to $100 or $1501




Clear plastic single-vision, lined bifocal, trifocal or lenticular lenses (any Rx) Included











Plastic photosensitive lenses $70



Contact lenses: Materials allowance Up to $100




Included

1 Enhanced $50 frame allowance is available at all Visionworks locations nationwide. 2 Discount not applicable at Walmart, Sam’s Club or Costco. 3 Davis Vision Collection is available at most participating independent provider offices. Frame collection is subject to change. 4 Polycarbonate lenses are covered in full for dependent children, monocular patients and patients with prescriptions +/- 6.00 diopters or greater.

Horizon Vista II (Horizon/Davis Vision View Network)

Effective 7/1/19-12/31/19

Horizon Panorama IIIA and IIIB (Horizon/Davis Vision View Network)

1 Copayment applies to Collection Contact Lenses only. 2 Members receive an additional $50 allowance at Visionworks retail locations.3 Additional discounts not applicable at Walmart, Sam’s Club or Costco locations.4 Davis Vision Collection is available at most participating independent provider offices. Frame collection is subject to change. 5 Polycarbonate lenses are covered in full for dependent children, monocular patients and patients with prescriptions +/- 6.00 diopters or greater.

Horizon Panorama IIIA Horizon Panorama IIIB

Once every:



Frame 12 months 24 months



Copayments

Eye examination / Spectacle lenses / Contact lens evaluation, fitting and follow-up care

$0 / $10 / $01




Davis Vision Frame Collection4 (in lieu of allowance): Fashion level / Designer level / Premier level Included / Included / $25


Clear plastic single-vision, lined bifocal, trifocal or lenticular lenses (any size or Rx)

Included

Oversize lenses / Tinting of plastic lenses / Scratch-resistant coating Included





High-index lenses / Intermediate-vision lenses / Polarized lenses $55 / $30 / $75




Non-collection contact lenses: Materials allowanceUp to $130



Collection Contact Lenses4 (in lieu of allowance):

– Disposable 4 boxes/multipacks

– Planned replacement 2 boxes/multipacks

Evaluation, fitting and follow-up care Included


Included

Effective 7/1/19-12/31/19

Horizon Panorama IVA and IVB (Horizon/Davis Vision View Network)

Horizon Panorama IVA Horizon Panorama IVBOnce every:




Contact lens evaluation, fitting & follow-up care 12 months




Contact lens evaluation, fitting and follow-up care $01

Eyeglass Benefit – Frame Member charges

Non-Collection frame allowance (retail) Up to $130 or $1802


Davis Vision Frame Collection4 (in lieu of allowance):

Fashion level / Designer level / Premier level Included / Included / $25

Eyeglass Benefit – Spectacle Lenses Clear plastic single-vision, lined bifocal, trifocal or lenticular lenses (any Rx) Included












Contact lenses: Materials allowance Up to $130


Evaluation, fitting & follow-up care –– standard and specialty lens types 15% discount3


– Disposable 4 boxes/multipacks 4 boxes/multipacks

– Planned Replacement 2 boxes/multipacks 2 boxes/multipacks


Medically required contact lenses (with prior approval) Materials, evaluation, fitting and follow-up care

Included

1 Copayment applies to Collection Contact Lenses only. 2 Enhanced $50 frame allowance is available at all Visionworks locations nationwide. 3 Discount not applicable at Walmart, Sam’s Club or Costco. 4 Davis Vision Collection is available at most participating independent provider offices. Frame collection is subject to change. Collection is inclusive of select torics and multifocals.5 Polycarbonate lenses are covered in full for dependent children, monocular patients and patients with prescriptions +/- 6.00 diopters or greater.

Effective 7/1/19-12/31/19

Horizon Expanse V (Horizon/Davis Vision View Network)

Horizon Expanse VOnce every:



Frame 12 months







Non-Collection frame allowance (retail): Up to $150 or up to $2002 plus a20% discount3 on any overage

Davis Vision Frame Collection4 (in lieu of allowance):

Fashion level / Designer level / Premier level Included

Eyeglass Benefit –– Spectacle Lenses Clear plastic single-vision, lined bifocal, trifocal or lenticular lenses (any Rx) Included


Tinting of plastic lenses Included


Polycarbonate lenses5 Included

Ultraviolet coating Included


Progressive lenses (standard / premium / ultra) Included / $40 / $90

Intermediate-vision lenses Included






Contact lenses: Materials allowance Up to $150 plus a

15% discount3 on any overage

Evaluation, fitting & follow-up care –– standard and specialty lens types 15% discount3



– Planned Replacement 4 boxes/multipacks



Included

1 Copayment applies to Collection Contact Lenses only. 2 Enhanced $50 frame allowance is available at all Visionworks locations nationwide. 3 Discount not applicable at Walmart, Sam’s Club or Costco.4 Davis Vision Collection is available at most participating independent provider offices. Frame collection is subject to change. Collection is inclusive of select torics and multifocals.5 Polycarbonate lenses are covered in full for dependent children, monocular patients and patients with prescriptions +/- 6.00 diopters or greater.

Effective 7/1/19-12/31/19

Horizon Expanse VI (Horizon/Davis Vision View Network)

1 Copayment applies to Collection Contact Lenses only. 2 Members receive an additional $50 allowance at Visionworks retail locations.3 Additional discounts not applicable at Walmart, Sam’s Club or Costco locations.4 Davis Vision Collection is available at most participating independent provider offices. Frame collection is subject to change. 5 Polycarbonate lenses are covered in full for dependent children, monocular patients and patients with prescriptions +/- 6.00 diopters or greater.

Horizon Expanse VI Once every:Eye examination including dilation (when professionally indicated) 12 months


Frame 24 months









Davis Vision Frame Collection4 (in lieu of allowance): Fashion level / Designer level / Premier level Included

Eyeglass Benefit –– Spectacle LensesClear plastic single-vision, lined bifocal, trifocal or lenticular lenses (any size or Rx)

Included


Polycarbonate lenses5 / Ultraviolet coating Included





Polarized lenses / Plastic photochromic lenses $75 / $65


Contact Lens Benefit (in lieu of eyeglasses):

Contact lenses: Materials allowanceUp to $150





– Planned replacement 4 boxes/multipacks



Included

Effective 7/1/19-12/31/19

Horizon Vista III and IV (Horizon/Davis Vision Select Network)

1 Enhanced $50 frame allowance is available at all Visionworks locations nationwide. 2 Davis Vision Collection is available at most participating independent provider offices. Frame collection is subject to change. 3 Polycarbonate lenses are covered in full for dependent children, monocular patients and patients with prescriptions +/- 6.00 diopters or greater.

Effective 7/1/19-12/31/19

Horizon Vista III Horizon Vista IV

Once every:






Copayments

Eye examination $0 $10

Spectacle lenses $10 $25


Non-collection frame allowance (retail):Up to $100 or up to $1501

plus a 20% discount on any overage



Clear plastic single-vision, lined bifocal, trifocal or lenticular lenses (any size or Rx) Included



Polycarbonate lenses (children3 / adults) $0 / $35












Evaluation, fitting and follow-up care –– standard and specialty lens types 15% discount


Included

Horizon Expanse VIIA and VIIB (Horizon/Davis Vision Select Network)

Horizon Expanse VIIA Horizon Expanse VIIB Once every:Eye examination including dilation (when professionally indicated) 12 months





CopaymentsEye examination $0 $10

Spectacle lenses $10 $25


Eyeglass Benefit –– Frame Member chargesNon-collection frame allowance (retail): Up to $150 or up to $2002


Davis Vision Frame Collection3 (in lieu of allowance): Fashion level / Designer level / Premier level Included


Included



Polycarbonate lenses (children4 / adults) Included














– Disposable Up to 8 boxes/multi-packs

– Planned replacement Up to 4 boxes/multi-packs



Included

1 Copayment applies to Collection Contact Lenses only. 2 Enhanced $50 frame allowance is available at all Visionworks locations nationwide. 3 Davis Vision Collection is available at most participating independent provider offices. Frame collection is subject to change. Contact lens collection is inclusive of select torics and multifocals.4 Polycarbonate lenses are covered in full for dependent children, monocular patients and patients with prescriptions +/- 6.00 diopters or greater.

Effective 7/1/19-12/31/19

Horizon Expanse VIII (Horizon/Davis Vision Select Network)

Horizon Expanse VIII Once every:Eye examination including dilation (when professionally indicated) 12 months


Frame 24 months







Non-collection frame allowance (retail):Up to $150 or up to $2002


Davis Vision Frame Collection3 (in lieu of allowance): Fashion level / Designer level / Premier level

Included


Included



Polycarbonate lenses (children4 / adults) Included


Anti-reflective (AR) coating (standard / premium / ultra) Included

Progressive lenses (standard / premium / ultra) Included

High-index lenses Included


Polarized lenses Included

Plastic photochromic lenses Included



Non-collection contact lenses: Materials allowance Up to $150plus a 15% discount on any overage



– Disposable Up to 8 boxes/multi-packs

– Planned replacement Up to 4 boxes/multi-packs



Included

1 Copayment applies to Collection Contact Lenses only. 2 Enhanced $50 frame allowance is available at all Visionworks locations nationwide. 3 Davis Vision Collection is available at most participating independent provider offices. Frame collection is subject to change. Contact lens collection is inclusive of select torics and multifocals.4 Polycarbonate lenses are covered in full for dependent children, monocular patients and patients with prescriptions +/- 6.00 diopters or greater.

Effective 7/1/19-12/31/19

Out-of-Network Reimbursement Schedule

Service Reimbursement up to:

Eye examination $40

Single-vision lenses $40

Frame $50

Bifocal/progressive lenses $60

Trifocal lenses $80

Lenticular lenses $100

Elective contact lenses $105 ($80 for Vista plans)

Medically required contact lenses $225

Your employees will always save the most when they use in-networkvision professionals.However, if they use a vision professional from outside the network, they will need to pay in full at the time of service and submit a claim for reimbursement. Horizon Vision offers the following reimbursement schedulefor all plans.

Pricing: Horizon/Davis Vision View NetworkEffective 7/1/19-12/31/19

Horizon Vista IPremium Rates (Voluntary)

Employee Only $7.71

Employee + Spouse $15.42

Employee + Child(ren) $16.18

Employee + Family $22.58

Premium Rates (Funded)Employee Only $5.34




Horizon Panorama IIIAPremium Rates (Voluntary)

Employee Only $8.81








Horizon Panorama IIIBPremium Rates (Voluntary)

Employee Only $7.33








Horizon Vista IIPremium Rates (Voluntary)

Employee Only $5.53








Pricing: Horizon/Davis Vision View NetworkEffective 7/1/19-12/31/19

Horizon Expanse VPremium Rates (Voluntary)

Employee Only $11.00








Horizon Panorama IVAPremium Rates (Voluntary)

Employee Only $7.67








Horizon Panorama IVBPremium Rates (Voluntary)

Employee Only $6.41








Horizon Expanse VIPremium Rates (Voluntary)

Employee Only $8.25








Horizon Vista IIIPremium Rates (Voluntary)

Employee Only $6.57








Horizon Vista IVPremium Rates (Voluntary)

Employee Only $4.88








Horizon Expanse VIIAPremium Rates (Voluntary)

Employee Only $9.34








Horizon Expanse VIIBPremium Rates (Voluntary)

Employee Only $7.24








Horizon Expanse VIIIPremium Rates (Voluntary)

Employee Only $9.80








Pricing: Horizon/Davis Vision Select NetworkEffective 7/1/19-12/31/19

Visionworks® is a trademark of UVP, LLC. All other trademarks are property of their respective ownersDavis Vision, Inc. supports Horizon Blue Cross Blue Shield of New Jersey in the administration of vision benefits. Davis Vision, Inc. is independent from and not affiliated with Horizon Blue Cross Blue Shield of New Jersey or the Blue Cross and Blue Shield Association. Products and policies are provided by Horizon InsuranceCompany and services are provided by Horizon Blue Cross Blue Shield of New Jersey, each an independent licensee of the Blue Cross and Blue Shield Association.Communications are issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its companies.The Blue Cross® and Blue Shield® names and symbols are registered marks of the Blue Cross and Blue Shield Association.The Horizon® name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey.© 2019 Horizon Blue Cross Blue Shield of New Jersey. Three Penn Plaza East, Newark, New Jersey 07105.

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2019 vision guide€¦ · contact lens beneﬁt (in lieu of eyeglasses) contact lenses: materials...

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