State of New Mexico. Effective July 1, 2016

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1 State of New Mexico Effective July 1, 2016

2 Plan Overview Eye Examination (Once every 12 months) Eyeglass Benefit Spectacle Lenses (Once every 12 months) Frame (Once every 24 months) Covered in Full after $10 copay Covered in Full after $15 copay Non-Collection Allowance $150 retail allowance, plus 20% off overage /1 $200 retail allowance at Visionworks stores, plus 20% off overage /1 Davis Vision Exclusive Collection /2 (in lieu of allowance) - Fashion -Designer -Premier Covered in Full Covered in Full Covered in Full Contact Lens Benefit (in lieu of allowance) (Once every 12 months) Contact Lens Evaluation, Fitting & Follow-Up Non-Collection Contacts $60 allowance, plus 15% off overage /1 Davis Vision Collection Contacts /2 Contact Lenses Covered in Full Non-Collection Allowance Up to $150 allowance plus 15% off overage /1 Davis Vision Collection Contacts /2 (in lieu of allowance) - Disposable - Planned Replacement Covered in Full 8 boxes / multi-packs 4 boxes / multi-packs Eye Examination: $40 Single-Vision Lenses: $40 Trifocal Lenses: $80 Elective Contacts: $105 Frame: $50 Bifocal / Progressive Lenses: $60 Lenticular Lenses: $100 Visually Required Contacts: $225 1/ Additional discounts not applicable at Costco, Sam s Club or Walmart locations. 2/ Collection is available at participating independent provider offices and is subject to change. 2

3 Frame Choice & Value 7 out of 10 members pick from the Collection 222 trendy and fashionable frames Fully-covered frames - up to $195 retail value Cost containment for both members & State of New Mexico Virtual Try-on-Tool available The Davis Vision Exclusive Collection is provided in addition to plan s in-network $150 retail allowance. Only applicable with the Davis Vision Collection. Warranty only applies to services and materials rendered after July 1,

4 Eyeglass Lenses & Coatings Clear Plastic Lenses (all ranges of prescriptions & sizes) Standard plastic material in single vision and lined bifocal or trifocal lens prescription COVERED Oversized Lenses Larger lenses for bigger frames COVERED Tinting of Plastic Lenses Gradient or solid lens tinting in various colors COVERED Scratch Resistant Coating Reduces risk of scratches COVERED Polycarbonate Lenses* Impact / shatter resistant lenses $0* / $30 Ultraviolet Coating Provides protection from UVA / UVB rays $12 Standard Anti-Reflective (AR) Coating Reduces internal / external reflection $35 Premium AR Coating Ultra AR Coating Reduces internal / external reflection plus they are easy-to-clean and more impact resistant Best anti-reflective benefits with the virtual elimination of reflections and glare Standard Progressives No-line bifocal for everyday use $50 Premium Progressives (Varilux, etc.) Provide a wider field of view in the distance and reading viewing areas Ultra Progressives (includes digital, free-form styles) Exceptional comfort and enhanced visual clarity $140 High-Index Lenses Thinner and lighter lenses $55 Polarized Lenses Sunglass lenses that also reduce glare $75 Plastic Photochromic Lenses (Transitions Signature ) Lenses that darken in the sunlight $65 Scratch Protection Plan (single vision / multifocal) Scratched lens replacement coverage $20 / $40 *Polycarbonate lenses COVERED IN FULL for dependent children, monocular patients and patients with prescriptions +/ diopters or greater. $48 $60 $90 Only applicable with the Davis Vision Collection. Warranty only applies to services and materials rendered after July 1,

5 Contact Lenses $60 allowance and 15% off overage $150 retail allowance and 15% off overage 5

6 Find A Better You At Visionworks $200 Over 1,500 frames covered in full with enhanced $200 frame allowance only at Visionworks Offers that include 50% off additional pairs when you use your benefit 700+ stores nationwide 6

7 Frame Choice & Value $10 $15 $65 FREE $90 7

8 Member Support Over 50,000 provider points of access including: - Independent optometrists & ophthalmologists - Retailers like Visionworks, Costco, Sam s Club, Walmart and Eye Associates of New Mexico No claim forms for in-network services Member welcome kit with ID cards & local provider listing Secure member website to locate providers, check benefits and more Mobile App for ios & Android 8

9 Questions? 7468 Benefit summaries Provider locator Online Exclusive Collection of frames Spanish language version available Brief educational videos Frame try-on tool 1 (800) and enter client code 7468 Live support (Mountain Time): Monday Friday 6 a.m. 9 p.m. Saturday 7 a.m. 2 p.m. Sunday 10 a.m. 2 p.m. Automated service available 24 / 7 9

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