Vision Care Plan: Claims Process

When using the Vision Care Plan, employees are responsible for selecting either

a participating provider, or
a nonparticipating provider.

If the employee chooses a participating provider, no claim form is required. The provider will obtain authorization to provide services directly from Davis Vision. If the employee chooses a nonparticipating provider, a "Direct Reimbursement Claim Form" is required. The "Direct Reimbursement Claim Form" is available under Vision Plan Claim Form (PDF) from the Forms page of the Employees: Benefits and Retirement business area.

An employee may locate a participating provider by using

the Davis Vision Interactive Voice Response (IVR) at 1-800-999-5431, or
the Davis Vision Web site at http://www.davisvision.com.

To find a participating doctor listed on the Davis Vision Web site, select the Find a Doctor button from their home page. Following the directions on the Member Login screen, the employee should

enter his or her social security number in the box next to "Member ID or Login Name"
enter his or her last name in the box next to "Password"
click the Submit button

The following table outlines the claims process for an enrolled employee who chooses a participating provider:

Step	Action
1	The employee selects a participating provider, contacts the provider, provides his or her Social Security Number, and schedules an appointment. Note: If the appointment is for a dependent, the dependent's date of birth must be provided.
2	The participating provider contacts Davis Vision to confirm enrollment and obtain authorization to proceed with services. Davis Vision may require the provider to complete additional forms to justify the services provided.
3	Payment is made directly to the provider by Davis Vision.

The following table outlines the claim process for enrolled employees who choose a nonparticipating provider:

Step	Action
1	The employee chooses a nonparticipating provider, schedules an appointment, and obtains a Direct Reimbursement Claim Form from Davis Vision or EPSS. The form is available under Vision Plan Claim Form (PDF) of the Forms Resource area in the Employees: Benefits and Retirement business area.
2	The employee pays for the service(s) and obtains a receipt. He or she can present the claim form at the time of service or afterwards, but the form must be completed by the provider before reimbursement will be made.
3	The employee submits the claim form and receipt to Davis Vision at the address shown on the form. Note: There is no time limit for submitting the form to Davis Vision provided that the employee is still eligible for coverage.
4	Davis Vision reviews the form for benefit determination and provides a check for allowable costs to the employee.

June 25, 2002 - Converted and updated be-a-74 (February 12, 1999) from Benefits Manual.

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