The optional vision program is a fully-insured, employee paid vision insurance program administered by Davis Vision and includes these benefits: eye examination, spectacle lenses, frames, and contact lenses. Contact lenses purchased from the Davis Vision Formulary at independent network provider offices include fitting and follow-up charges. Retail locations and optometrists affiliated with these locations do not offer the Davis Vision Formulary or the Davis Vision Eyeglass Collection options. This vision insurance plan is optional coverage and is not included as part of your health plan benefits. Those enrolled in the UVa Health Plan will continue to receive the Discount Vision Plan as part of their UVa Health Plan benefits. Participation in the UVa Health Plan is not necessary to enroll in the optional vision insurance offered by Davis Vision.
In order to be covered under the Davis Vision Plan, an employee must be a salaried employee of the University of Virginia who is either regularly scheduled to work at least twenty hours per week (50% effort), or a Health System employee who works 40 hours a week or who has signed a Medical Center Flexible Staffing Contract.
Those persons eligible to be dependents on the plan are legally recognized spouses in the Commonwealth of Virginia and children through December 31st of the year in which they turn 26. Children include biological children, step children, adopted children, and foster children. Children can remain on the health plan through December 31st of the year in which they turn 26. Other children for whom you are the legal guardian with permanent custody who are unmarried, live with you 100% of the time in a parent-child relationship, and are declared as a dependent on your federal tax return can remain on the vision plan through December 31st of the year in which they turn 26.
Coverage for dependent children who are incapable of self-support due to a mental or physical handicap may continue beyond age 26 if proof of the handicap is furnished to and approved by the Claims Administrator PRIOR to the dependent's 26th birthday and they are unmarried, live with you 100% in a parent-child relationship, and are declared as a dependent on your federal tax return.
Enrollment Rules and Coverage Effective Date
Coverage begins on the first day of the first full month of employment, if an application is filed within 60 days of employment. If an employee's first day of work is the first working day of the month, coverage begins that day when the employee's application is received within 60 days of employment. Changes in membership may only be made at the annual Open Enrollment, or subsequent to a valid mid-year qualifying event. Events that constitute a mid-year qualifying event include:
marriage, divorce, or annulment
birth or adoption/placement for adoption
loss of dependent eligibility (only acceptable reason is when employee loses permanent custody of "other child")
employment status of employee, dependent, or spouse which affects eligibility to participate in the Davis Vision
commencement of or returning from an unpaid leave of absence
judgment, decree, or order changing legal custody
cost and/or coverage changes in employee’s, dependent’s or spouse’s vision plan
entitlement to or loss of eligibility for Government-sponsored vision programs ;or
death of spouse or dependent
Changes in membership must be received in the University Human Resources Benefits Division within 60 days of the qualifying event or within the same plan year as the mid-year qualifying event and are effective the first of the month following receipt of the form (on-line or paper) unless they are terminating due to ineligibility. Those enrollment changes are effective the first of the month following the qualifying event. Applications for changes due to birth or adoption of a child that are received within 60 days of the event are applicable for the newborn or adopted child on the date the birth or adoption occurs. The premium change, if appropriate, is effective the first of the month in which the birth or adoption occurs. Changes to other family members are effective the first of the month following receipt of the form. If submitting an application more than 60 days after the date of birth or adoption but within the same plan year, the coverage will be effective the first of the month following receipt of the application. Applications not submitted on a timely basis will be processed when the next open enrollment period occurs if crossed over into the next plan year.
Any ineligible dependents found on the Davis Vision Plan will be terminated on the last day of the month in which they became ineligible. Changes in the employee's coverage category to match this termination of dependent's coverage are subject to IRS Section 125 Regulations. Employee-participants with ineligible dependents enrolled on their policy may be suspended from the Plan for up to three (3) years.
Extended Coverage Terminating employees and dependents who lose eligibility for coverage may have the option to extend continuous health care coverage through enrollment in Extended Coverage under the provisions of the Consolidated Omnibus Budget Reconciliation Act (COBRA). See COBRA Eligibility, Rates and Enrollment.
Davis Vision Rates
|Coverage Level||Monthly Rate|
|Employee + Child(ren)||$11.01|
|Employee + Spouse||$11.33|
Davis Vision Summary Information
Davis Vision Website - Davis Vision (click on ‘Member’, enter ‘Control Code’ 4680, and click on ‘Submit’)
Davis Vision Customer Service - 1.800.804.6115
Links and Forms
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