2017-2018 Mosaic Overview

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P A G E 9
Vision Benefits NVA Vision Program
A comprehensive vision program including routine eye examinations, eyeglasses and
contact lenses is available through NVA Vision. The vision plan offers a national
network consisting of optometrists, ophthalmologists and opticians. To find a provider,
go to and utilize the “Find a Doctor” feature or call (800) 672-7723 for
a list of network providers near you.
Employee Payroll Deductions (per pay)
Employee Only $0.00
Employee/Spouse $2.00
Employee/Child $1.50
Employee/Children $1.50
Enrollment Tier Payroll Deduction
Family $2.50
Benefit (12-month period) NVA Vision Program
In-Network Out-of-Network
Eye Examinations (once/year)
Routine Eye Exam Covered 100% Reimbursed up to $31
Frames
Contracted Frame Provider Covered up to $5 Retail Allowance
(35% discount on remaining balance) Up to $4
Spectacle Lenses
Basic Single Vision (Lenticular)
Basic Bifocal
Basic Trifocal
$35
$55
$70
Up to $29
Up to $39
Up to $47
Contact Lenses
Medically Necessary Contacts Covered up to $5 Retail Allowance $250
Formulary Lenses
Other Single Vision Contacts
Other Bifocal Contacts
(15% discount off balance for
conventional or 10% off balance for
disposal)
Up to $3
Lens Options*
Transition Lenses
Scratch-Resistant Coating
Ultraviolet Coating
Tinting
Oversize Lenses
Polarized Lenses
$65 Single Vision, $70 Multi-Focal
$10
$12
$12 Solid/Gradient Tint
See Carrier Benefit Summary
$75
See Carrier Benefit Summary
Laser Vision Correction
15% off standard prices or 5% off promotional pricing
*Lens Options list is not exhaustive; additional options may be available. Consult your carrier benefit summary for details.