Vision NATIONAL VISION ADMINISTRATORS (NVA) - Savannah, GA
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Vision NATIONAL VISION ADMINISTRATORS (NVA)
2022
Vision
Benefit
Highlights
© 2020 USI Insurance Services. All rights reserved.
National Vision Administrators, L.L.C.
Your NVA Vision Benefit Summary
City of Savannah
Effective 01/01/2022
Group Number# 3276
Schedule of Vision Benefits
How Your Vision Care Program Works
Eligible members and dependents are entitled to
Non-Participating receive a vision examination and one (1) pair of
Participating
Benefit Frequency Provider lenses and a frame or contact lenses and contact
Provider lens evaluation/fitting once every calendar year.
Examination Reimbursed Amount For your convenience, at the start of the program,
▪ Covered 100% ▪ Up to $45 you will receive two identification cards with
Once Every Calendar Year
After $20 copay participating providers in your zip code area listed
Lenses on the back. At the time of your appointment, simply
present your NVA identification card to the provider
Once Every Calendar Year Standard Glass or Plastic
or indicate that your benefit is administered by NVA.
The provider will contact NVA to verify eligibility. A
▪ Single Vision ▪ Covered 100% ▪ Up to $30
vision claim form is not required at an NVA
▪ Bifocal After $30 copay ▪ Up to $50
participating provider.
▪ Trifocal ▪ Up to $65
▪ Lenticular ▪ Up to $100
Be sure to inform the provider of your medical
Frame Retail Allowance history and any prescription or over-the-counter
Once Every Calendar Year ▪ Up to $200 ▪ Up to $55 (OTC) medications you may be taking.
(20% discount off
balance)* To verify your benefit eligibility prior to calling or
visiting your eye care professional, please visit our
Contact Lenses In lieu of In lieu of
website at www.e-nva.com or download our mobile
Once Every Calendar Year Lenses Lenses
app by searching NVA Vision, or contact NVA’s
Customer Service Department toll-free at
Elective Contact Lenses ▪ Up to $200 Retail ▪ Up to $105
1.800.672.7723 (TDD line 1-888-820-2990) or NVA’s
(15% discount
(Conventional) or 10% Interactive Voice Response (IVR). Customer Service
is available 24 hours a day, 7 days a week, 365 days
discount (Disposable)
off balance)** a year. Any question any time.
Fit/Follow-Up*** If you are not a registered subscriber, you can still
Standard Daily Wear ▪ Covered 100% after ▪ Up to $20 search our providers online by selecting the “Find a
$20 copay Provider” link on our home page. Enter group
Standard Extended Wear ▪ Covered 100% after ▪ Up to $30 number 3276000001 or the group number on the
$30 copay identification card and enter in your search
Specialty Wear ▪ Covered 100% after ▪ Up to $50 parameters. It’s that easy!
$50 copay
Medically Necessary**** ▪ Covered 100% ▪ Up to $210 Includes frames up to $110 every day low price-
price point at Walmart/Sam’s Club locations.
Low Vision Aids****
Once Every Two Calendar $200 every day low price-price point for contact
Years lenses at Walmart/Sam’s Club locations.
Supplementary Testing ▪ Covered 100% ▪ Up to $125
Supplemental Aids ▪ Up to 75% of $1000 ▪ Up to $75% of $1000
*Does not apply to Wal-Mart / Sam’s Club or Lenscrafters locations or for certain proprietary brands. **Does not apply to Wal-Mart/Sam’s Club,
Lenscrafters, Contact Fill (NVA Mail Order) or certain locations at: Target, Sears, Pearle, & K-Mart and may be prohibited by some manufacturers.
***Only covered if you choose Contact Lenses. ****Pre-approval from NVA required.
Fixed prices/courtesy discount do not apply at Walmart/Sam’s Club and LensCrafters locations.
Lens options purchased from a participating NVA provider will be provided to the member at the amounts listed in the fixed option pricing list below:
▪ $75 Polarized $25 Polycarbonate (Single Vision) 20% discount AR Coating – Tier 5
▪ $30 Blended Bifocal (Segment) $30 Polycarbonate (Multi-Focal) $50 Progressive Tier -1
▪ $40 Blue Light Blocker (Standard) $10 Scratch-Resistant Coating (Standard $80 Progressive – Tier 2
▪ $60 Blue Light Blocker (Premium) $65 Transitions Single Vision (Standard) $100 Progressive – Tier 3
▪ $150 Blue Light Blocker (Ultra) $70 Transitions Multi-Focal (Standard) $120 Progressive – Tier 4
▪ $12 Fashion Gradient $10 Solid Tint $140 Progressive – Tier 5
▪ $20 Glass Photogrey (Single Vision) $40 AR Coating – Tier 1 $165 Progressive – Tier 6
▪ $30 Glass Photogrey (Multi-Focal) $50 AR Coating – Tier 2 $190 Progressive – Tier 7
▪ $55 High Index $65 AR Coating – Tier 3 20% discount Progressive – Tier 8
▪ $12 Ultraviolet Coating $80 AR Coating – Tier 4 $39 Retinal Screening
For lens options & services purchased from a participating NVA provider, NVA members will only pay the fixed maximum amount or the provider’s Usual and Customary
(U&C) charge less 20%, whichever is less. Options not listed will be priced by NVA providers at 20% off the Provider’s Retail (U&C) price. Fixed prices are available in-
network only. Discounts are not insured benefits. In certain states, members may be required to pay the full retail amount and not the negotiated discount amount at
certain participating providers. Some optometrist affiliated with Optical Retail locations (i.e., LensCrafters, Walmart, Visionworks, etc.) are independent providers and
may not participate in the NVA program.
www.e-nva.com Page 1
Get a Better View
Participating providers are not contractually obligated to offer sale prices in addition to outlined coverage. Regardless of medical or optical necessity, vision
benefits are not available more frequently than specified in your policy.
Plan Specific Details Online: The NVA website is easy to use and provides the most up to date information for program participants:
-Locate a nearby participating provider by name, zip code, or City/State, Verify eligibility for you or a dependent
-View benefit program and specific detail, Review claims, Print ID cards (when applicable), Nominate a non-participating provider to join the
NVA network
Examinations: The comprehensive exam includes case history, examination for pathology or anomalies, visual acuity (clearness of
vision), refraction, tonometry (glaucoma test) and dilation (if professionally indicated).
Lenses: NVA provides coverage in full for standard glass or plastic eyeglass lenses.
Frames: Select any frame from the participating provider’s inventory. Any amount in excess of your plan allowance is the member’s
responsibility. Frame choices vary from office to office. (Visit NVA’s website to view the Benefit maximizer Program)
Contact Lenses: The contact lens benefit includes all types of contact lenses such as hard, soft, gas permeable and disposable lenses.
Medically necessary contact lenses includes fitting and follow up and may be covered with prior authorization when prescribed for: post
cataract surgery, correction of extreme visual acuity problems that cannot be corrected to 20/70 with spectacle lenses, Anisometropia or
Keratoconus.
Non-Participating Providers: You will be responsible for one hundred percent (100%) of the cost at the time of service at a non-
participating provider. You can request a claim form from NVA via the website www.e-nva.com or you may submit receipts along with a
letter containing the member’s full name, patient’s full name, address, ID# and sponsoring organization to NVA, P.O. Box 2187, Clifton, NJ
07015.
Laser Eye Surgery: NVA has chosen The National LASIK Network to serve their members. This network was developed by LCA
Vision in 1999 and is one of the largest panels of LASIK surgeons in the U.S. Members are entitled to significant discounts and a free
initial consultation with all in-network providers.
Hearing Discount: You will receive up to 60% savings at participating provider locations through NationsHearing®.
Discounts: In addition to your funded Your NVA EyeEssential® Plan Discount – In Network Only
benefit you are eligible to access the Service Participating Provider Lens Options
EyeEssential® Plan discount (in Member Cost:
Network Only) on additional purchases Eye Examination: Retail Less $10 $12 Solid Tint/ Gradient Tint
during the plan period. Please see $50 Standard Progressive Lenses
table for more detail regarding NVA’s Contact Lens Fitting: Retail Less 10% $75 Polarized Lenses
discount plan: $65 Transitions Single Vision Standard
$70 Transitions Multi-Focal Standard
*Discount is not applicable to mail order;
Lenses: Glass or Plastic $15 Standard Scratch Coating
however, you may get even better pricing Single Vision $35.00 $12 UV Coating
on contact lenses through Contact Fill. Bifocal $55.00 $35 Polycarbonate
Trifocal or Lenticular $70.00 $45 Standard Anti-Reflective
Frame: Retail Less 35%
Contact Lenses*: Member Cost:
Conventional Retail Less 15%
Disposable Retail Less 10%
Lens options purchased from a participating NVA provider will be provided to the member at the amounts listed in the fixed option price list above.
Options not listed will be priced by NVA providers at 20% off the Provider’s Retail (U and C) price.
Wal-Mart / Sam’s Club and Lenscrafters stores do not provide additional discounts.
Some optometrist affiliated with Optical Retail locations (i.e., LensCrafters, Walmart, Visionworks, etc.) are independent providers and may not participate in
the NVA program.
At NVA, We Work Only for Our Clients.
Insurance coverage provided by National Guardian Life Insurance Company (NGLIC), 2E Gilman, Madison, WI 53703. Policy NVIGRP 5/07. NGLIC is not affiliated with the Guardian Life Insurance Company of
America, a/k/a The Guardian or Guardian Life. A full description of your coverage, its limitations, exclusions and conditions is contained in the Insurance Policy issued to your Plan Sponsor at its place of business.
That full description in the form of a Certificate of Coverage can be made available to you by requesting it from your Plan Sponsor.
Exclusions / Limitations: No payment is made for medical or surgical treatments / Rx drugs or OTC medications / non-prescription lenses / two pair of glasses in lieu of bifocals / subnormal visual aids / vision
examination or materials required for employment / replacement of lost, stolen, broken or damaged lenses/ contact lenses or frames except at normal intervals when service would otherwise be available /
services or materials provided by federal, state, local government or Worker's Compensation / examination, procedures training or materials not listed as a covered service / industrial safety lenses and safety
frames with or without side shields / parts or repair of frame / sunglasses.
National Vision Administrators, L.L.C. ▫ PO Box 2187 ▫ Clifton, NJ 07015 This document is intended as a program overview
Web: www.e-nva.com ▫ Toll-Free: 1.800.672.7723 only and is not a certified document of the
NVA® and EyeEssential® are registered marks of National Vision Administrators, L.L.C. individual plan parameters.
Page 2
www.e-nva.com
Are you
interested
in LASIK?
NVA members have access to the National
EXTRA MEMBER VALUE
LASIK Network, offering the following:
Only at LasikPlus!
ACCESS TO PROVIDERS
SAVE
800
The National LASIK Network is one of the largest networks in
the U.S. with over 600 locations nationwide. $ ^
QUALITY on LASIK!
All providers are credentialed every 3 years and must meet
National LASIK Network quality standards to participate.
PLUS
MEMBER VALUE • Free LASIK exam (over $100 value)
All in-network providers are contracted to extend the following • All LASIK procedures are 100% bladeless
15% off standard prices or 5% off promotional prices. • FREE enhancements for life on most treatments
• Guaranteed Financing‡
Call 877-295-8599 or visit
www.e-nvalasik.com
for providers in your area or to activate your discount.
Copyright© 2018 LCA-Vision, Inc. dba LasikPlus®. ^Only members of participating partnerships, health and vision plans who schedule via their plan are entitled to this limited time offer. Savings is $400 per eye on a Custom Wavelight Treatment with Lifetime Advantage Plan. Limited time offer. Discount
may not be combined with any other discount. ‡Financing Options Guaranteed: Excludes Ft. Lauderdale, Northville and Oklahoma City LasikPlus locations. Certain conditions apply. Down payment varies based on FICO score. Interest rate varies by length of term selected. See website for details. NVA members are
served through the National LASIK Network administered by LCA-Vision. NVA logo is a registered mark of National Vision Administrators, L.L.C. v01212014 .
Save thousands on hearing aids,
starting as low as $500!
National Vision Administrators (NVA) has partnered with NationsHearing® to offer you a
full-service hearing aid discount program. We make the process of selecting hearing aids as
convenient and affordable as possible by scheduling a no-cost hearing test and offering up
to 60% savings on the most comfortable and effective hearing aids.†
Getting started is easy:
CALL:
Call us at 877-272-9627 (TTY: 711) and speak with a Member Experience
Advisor to schedule your hearing test with a local provider.
TEST:
If the test results show hearing loss, we will work with you to select the
highest quality hearing aids using your hearing aid discount.
FIT:
We work with your provider to fit your hearing aids and schedule any
necessary follow-up appointments.
FOLLOW-UP:
To ensure your complete satisfaction, a representative will contact you
to see if you need any further assistance.
To get started, call 877-272-9627 (TTY: 711).
Representatives are available Monday through Friday, 8 a.m. to 8 p.m. ET.
†Compared to industry pricing.
Program features include:
Annual hearing test with no out-of-pocket cost
Access to a nationwide network of
8,000+ providers
State-of-the-art hearing aids from all major
manufacturers, including Starkey, Phonak
and ReSound
Low pricing and a 60-day, 100%
money-back guarantee City of Savannah
Concierge services by dedicated Member 1/1/2022
Experience Advisors
3 follow-up visits with your provider
3-year manufacturer’s repair warranty
3 years of batteries*
One-time replacement coverage for lost, stolen or damaged hearing aids**
12 or 18-month financing options available with 0% APR, no money down
Hearing Aid Pricing Overview
Average Retail Price Member Price
Technology Level
Per Hearing Aid Per Hearing Aid
Entry $1,250 $500
Basic $1,500 $675
Prime $2,000 $975
Advanced $2,750 $1,575
Premium $3,250 $1,975
Hearing Hunt is a fun and challenging word search game designed to sharpen
your clarity of hearing.
The game uses a multi-themed display with sound clues that ask you to listen
and find hidden words while earning rewards and receiving healthy hearing
tips. The auditory experience is especially helpful when paired with Bluetooth®
hearing aids.
Download Hearing Hunt today!
Hearing aids starting as low as $500.
Visit NationsHearing.com/NVA to learn more.
*Not applicable with the purchase of rechargeable hearing aid models. **Deductibles may apply.
©2021 Bluetooth SIG, Inc. // Google Play and the Google Play logo are trademarks of Google LLC. // The iPhone® is a registered trademark of Apple Inc.
©2021 NationsBenefits, LLC. All rights reserved. The NVA logo is a registered mark of National Vision Administrators, L.L.C.
01292021
NVA Smart Buyer®:
National Vision Administrators, L.L.C. The Consumer’s Guide to Vision Benefits
Members, access the NVA Smart Buyer® at www.e-nva.com to get the most out of your
vision benefit, while paying the least out-of-pocket cost on eye glasses!
What is NVA Smart Buyer®
The NVA Smart Buyer® gives you the inside-scoop on how to buy eye glasses to fit your needs and budget. It
provides answers to questions such as:
• How many frames does my Eye Care Professional (ECP) carry that are covered by my insurance at $0
out-of-pocket cost to me?
• How do I determine which frames will look good on me?
• How do I know which lenses and lens coatings are right for me?
NVA Smart Buyer® Features
# Of Frames
Service Level Available At $0* Distance
Find an Eye Care Professional based on frame
Full Service** 480 Of 800
Total Frames
< 1 Mile
View Map
inventory at $0 out-of-pocket cost and
save money with our Smart Buyer Tips!
© 2016. NVA logo and NVA Smart Buyer® are registered marks of NaƟonal Vision Administrators, L.L.C. v09022016
Polishing the lens' edges provides a cleaner
look to your eyeglasses but is an additional
expense.
Cool Cool Skin Tone – skin shows blue or pinkish
tones, skin is usually red and / or rosy (Having trouble
determining your shade?) Look at the veins on the
Find out which frames look best on
Bridge Size (mm)
Eye Size (mm)
Suggested Frame Colors – colors with ‘icy’ shades
you by face shape, hair color, Temple
Length
skin tone and more! (mm)
Ultraviolet Protection Treatment
Smart Buyer
Pros Cons
Suggestions
Pick out lens types and lens coatings based
Additional cost for
application, if not
already applied to
lens
Blocks the sun’s UV
rays from damaging
the delicate tissue of
on your prescription and lifestyle!
the eyes
Reduces risk of
retinal damage, Recommended for
Get a better view
view.
You deserve a better view. Let NVA help you get it.
Log in as a member at www.e-nva.com to access the NVA Smart Buyer and more!You can also read
