Transcription of Avēsis Advantage Plan Matrix - opticaladmin.com
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Avēsis Advantage Plan Matrix - opticaladmin.com
*7IU9101C9131C914*1I9161C9171I9198C9238C 924*8I9268C9278I9329C9339I9369I93911F940 MO $10I9418H9427I9458I94717I950MO $10C951EO $0N/A95210C953EO $15N/A954EO $0N/A95613I95710I9608I961*10I962* $0I9701A97116K97210I97611C977EO $20DD978MO $0I979MO $10I980MO $10I9828J986MO $15I9877I9881J9891J9908J991MO $10J91001H91029H910310H910510I910711C911 11K91129K91138S911611H911810H9119MO $25H912010C912110I912217C9123MO $15H912410C912911I9133MO $ *11I91468K91478K914917I915216I915311C915 48H915511H916014H916217H91651H91667K9167 18H91697H917017C917216H91735I91748K91751 S918111C918911$200/$13092019K9207MO $25I92108Q92137I921411K92168S92179K9218M O $25C922111S92259S92265I92277I9228EO $0 $0J92565I92577Q925810I92591H926020$80/$2 00926114I93001V940717S97018I9900N/ADisco untD = Diabetic Eye ProgramDCPG = Internal to Av sisDisc = Up to 20% discount off retail where permissable DR = Internal to Av sisEO = Exam OnlyH = Internal to Av sisI = Industrial Safety ProgramLV = Low Vision ProgramMO = Materials OnlyN/A = No BenefitNC = Internal to Av sisNE = Internal to Av sisP = L1PG = L4U = Internal to
Access all information on Guardian Vision plans with the knowledge center on the Avēsis provider portal. GUARDIAN VISION PLAN NUMBERS Rev. 1/2018
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