horizon visionworth a second look€¦ · contact lens evaluation, fitting and follow-up care 12...

HorizonBlue.com

Horizon Vision...Worth a Second LookFor Groups with 51 or more Employees

Since 1932, Horizon Blue Cross Blue Shield of New Jersey has been providingprotection and peace of mind to our customers. And we look forward to doingthe same 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 BCBSNJ?Horizon BCBSNJ can help you and your employees make smart health benefit decisions. With 3.8 million members and more than 80 years’ experience, Horizon BCBSNJ is New Jersey’s most trusted insurer.

Horizon BCBSNJ offers:• An array of employee benefits products, including medical, pharmacy, dental, life and

disability, in addition to vision coverage.• Access to providers across the nation — and the world.• Innovative models of care to help improve health outcomes while lowering the total cost

of care.

As part of our vision to lead the transformation of health care in New Jersey, we use aggregated member data to show you how certain chronic health conditions correlatewith medical expenses and wellness — and why it pays to combine coverage from one carrier.

You’ll see why encouraging your employees to use their vision benefits will help them stayhealthy — and avoid costly medical issues down the road.

With a Horizon Vision plan, you can help keep your employees seeing clearly allyear long!

We’re a proud member of the Blue Cross and Blue Shield Association, one of the largest, best known and most respected names in health insurance.

Our Horizon Vision plans are administered by Davis Vision, which delivers care through an

end-to-end approach.

All Horizon Vision plans offer:

• Savings on additional eyeglasses, sunglasses and disposable contact lenses

• A one-year breakage warranty

• Mail-order contact lenses

• Discounts on laser vision correction

• Low-vision services

• Eye health and wellness education

Horizon Vision: Powered by a national industry leader

Our NetworksAll Horizon Vision plans use Davis Vision’s core nationwide network of independent retailers

and Visionworks locations. These 30,000 eye care professionals make up the Horizon/Davis

Vision Select network.

Many of our plans, however, leverage the expanded Horizon/Davis Vision View network, which

contains an additional 20,000 eye care professionals throughout the country.

Each plan described on the following pages indicates which network it uses.

Members can locate in-network providers through Horizon BCBSNJ’s Online Doctor &

Hospital Finder at HorizonBlue.com/doctorfinder.

1 Members receive an additional $50 allowance at Visionworks retail locations.2 Davis Vision Collection is available at most participating independent provider offices. Collection is subject to change. 3 Additional discounts not applicable at Walmart, Sam’s Club or Costco locations.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 IFrequency – Once Every:

Eye examination inclusive of 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

CopaymentsEye 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 Included

– Designer level $15

– Premier level $40

Eyeglass Benefit – Spectacle LensesClear 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 allowance Up to $100 plus a 15% discount on any overage2

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

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

Out-of-Network Reimbursement Schedule – Up to:Eye examination: $40 Single-vision lenses: $40 Trifocal lenses: $80 Elective contact lenses: $80

Frame: $50 Bifocal/progressive lenses: $60 Lenticular lenses: $100 Visually required contact lenses: $225

Horizon Vista IIFrequency –– Once Every:



Frame 24 months





Eyeglass Benefit – Frame Member ChargesNon-Collection frame allowance (retail): Up to $100 or $1501

plus a 20% discount2 on any overage





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











Plastic photosensitive lenses $70


Contact Lens Benefit (in lieu of eyeglasses):Contact lenses: Materials allowance Up to $100


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

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

Included

Out-of-Network Reimbursement Schedule – Up to: Eye examination: $40 Single-vision lenses: $40 Trifocal lenses: $80 Elective contact lenses: $80

Frame: $50 Bifocal/progressive lenses: $60 Lenticular lenses: $100 Medically necessary contact lenses: $225

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. 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)

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. 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 IIIBFrequency – Once Every:



Frame 12 months 24 months



CopaymentsEye examination / Spectacle lenses / Contact lens evaluation, fitting and follow-up care $0 / $10 / $01






– Designer level 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 allowance Up to $130 plus a 15% discount on any overage3


Collection Contact Lenses4 (in lieu of allowance):

– Disposable 4 boxes/multipacks

– Planned replacement 2 boxes/multipacks

Evaluation, fitting and follow-up care Included




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

Frequency –– Once Every:Eye examination inclusive of dilation (when professionally indicated) 12 months



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




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

Eyeglass Benefit – Frame Member ChargesNon-Collection frame allowance (retail): Up to $130 or $1802








Tinting of plastic lenses Included











Contact Lens Benefit (in lieu of eyeglasses):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

Evaluation, fitting & follow-up care Included

Visually required contact lenses (with prior approval) – Materials, evaluation, fitting & follow-up care Included

Out-of-Network Reimbursement Schedule – Up to: Eye examination: $40 Single-vision lenses: $40 Elective contact lenses: $105

Frame: $50 Bifocal/progressive lenses: $60 Medically necessary contact lenses: $225

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. 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.

Trifocal lenses: $80

Lenticular lenses: $100

Horizon Expanse V (Horizon/Davis Vision View Network)

Horizon Expanse VFrequency –– Once Every:



Frame 12 months





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

Eyeglass Benefit – Frame Member ChargesNon-Collection frame allowance (retail): Up to $150 or up to $2002 plus a

20% discount3 on any overage




– Premier level Included





Polycarbonate lenses5 Included

Ultraviolet coating Included


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

Intermediate-vision lenses Included





Contact Lens Benefit (in lieu of eyeglasses):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


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

Out-of-Network Reimbursement Schedule – Up to: Eye examination: $40 Single-vision lenses: $40 Trifocal lenses: $80 Elective contact lenses: $105

Frame: $50 Bifocal/progressive lenses: $60 Lenticular lenses: $100 Medically necessary contact lenses: $225

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. 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.

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. 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 VIFrequency – Once Every:



Frame 24 months












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

Polycarbonate lenses5 / Ultraviolet coating Included





Polarized lenses / Plastic photochromic lenses $75 / $65



Contact lenses: Materials allowance Up to $150 plus a 15% discount on any overage3




– Planned replacement 4 boxes/multipacks





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

Horizon Vista III Horizon Vista IVFrequency –– Once every:






CopaymentsEye examination $0 $10

Spectacle lenses $10 $25

Eyeglass Benefit – Frame Member ChargesNon-collection frame allowance (retail): Up to $100 or up to $1501

plus a 20% discount on any overage








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









Contact Lens Benefit (in lieu of eyeglasses):Non-collection contact lenses: Materials allowance Up to $100



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

Included



1 Enhanced $50 frame allowance is available at all Visionworks locations nationwide. 2 Davis Vision Collection is available at most participating independent provider offices. 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.

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

Horizon Expanse VIIA Horizon Expanse VIIBFrequency –– Once every:






CopaymentsEye examination $0 $10

Spectacle lenses $10 $25


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









Polycarbonate lenses (children4 / adults) Included













– Disposable Up to 8 boxes/multi-packs

– Planned replacement Up to 4 boxes/multi-packs


Visually 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 Davis Vision Collection is available at most participating independent provider offices. 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.

Horizon Expanse VIII (Horizon/Davis Vision Select Network)

Horizon Expanse VIII Frequency –– Once every:



Frame 24 months






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






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

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






– Disposable Up to 8 boxes/multi-packs

– Planned replacement Up to 4 boxes/multi-packs


Visually 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 Davis Vision Collection is available at most participating independent provider offices. 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.

Pricing: Horizon/Davis Vision View NetworkHorizon Vista I

Premium Rates (Voluntary)Employee Only $7.23

Employee + Spouse $14.46

Employee + Child(ren) $19.52

Employee + Family $28.19

Premium Rates (Funded)Employee Only $4.60




Horizon Panorama IIIAPremium Rates (Voluntary)

Employee Only $8.26








Horizon Panorama IIIBPremium Rates (Voluntary)

Employee Only $6.88








Horizon Vista IIPremium Rates (Voluntary)

Employee Only $5.19








Pricing: Horizon/Davis Vision View Network

Horizon Expanse VPremium Rates (Voluntary)

Employee Only $10.32








Horizon Panorama IVAPremium Rates (Voluntary)

Employee Only $7.19








Horizon Panorama IVBPremium Rates (Voluntary)

Employee Only $6.01








Horizon Expanse VIPremium Rates (Voluntary)

Employee Only $7.74








Pricing: Horizon/Davis Vision Select NetworkHorizon Vista III

Premium Rates (Voluntary)Employee Only $6.16








Horizon Vista IVPremium Rates (Voluntary)

Employee Only $4.57








Horizon Expanse VIIAPremium Rates (Voluntary)

Employee Only $8.76








Horizon Expanse VIIBPremium Rates (Voluntary)

Employee Only $6.79








Horizon Expanse VIIIPremium Rates (Voluntary)

Employee Only $9.19








Facebook® is a registered mark of Facebook, Inc. Twitter™ is a registered trademark of Twitter, Inc. YouTube™ is a trademark of Google, Inc. Davis 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.© 2016 Horizon Blue Cross Blue Shield of New Jersey. Three Penn Plaza East, Newark, New Jersey 07105.

31714 (0616)

Connect with us on social media

horizon visionworth a second look€¦ · contact lens evaluation, fitting and follow-up care 12...

Documents