Eyewear formulary for Versant Health m embers

1 Eyewear formulary for Versant Health members Versant Health is pleased to present the formulary associated with its Eyewear dispensing program. As part of our vision to make Davis Vision and Superior Vision the most trusted vision plans for eye care professionals, Versant Health has undertaken a number of operational enhancements, including investments in operations, call center services, and streamlined payment technology. Our Eyewear dispensing program, which includes the following formulary and a state-of-the-art eye care professional portal, is among our most exciting enhancements! We have entered in to an agreement with Essilor to fulfill lab orders using its nation-wide laboratory network.

2 You will now dispense Eyewear orders from a catalogue featuring innovative products from Essilor, Shamir, and Kodak. You will see that the formulary includes a wide array of high quality Eyewear using advanced technology and broad choice in lens functionality. Essilor is the largest Eyewear manufacturer in the world with a nation-wide network of labs. Through this agreement, we are able to offer you and your patients: a large variety of lenses, including the most utilized and requested digital progressives, antireflective coatings, and blue light protection, access to innovative products as a result of Essilor's industry-leading research and development investments, a network of labs across the country, which can improve turnaround time on orders and cost stabilization due to the purchasing power Versant Health 's 37.

3 Million members give us. We look forward to continued service to you and your patients. Please see the back page for the updated Eyewear formulary . Brought to you by Progressive addition (PAL) and intermediate lens formulary : Commercial / Medicare Digital SV and computer Standard Premium Ultra Ultimate lenses (intermediate). Eyezen Start Adaptar Accolade varilux comfort Max varilux Physio W3+. Eyezen+ 0 SmallFit varilux comfort varilux comfort Max Fit varilux Physio W3+Fit Eyezen+ 1 Essilor Ideal varilux comfort Short varilux comfort Enhanced varilux Physio W3+Eyecode Eyezen+ 2 Essilor Ideal Short varilux Physio varilux comfort Enhanced Fit varilux S Design Eyezen+ 3 Essilor Ideal Computer varilux Physio Short varilux Physio Enhanced varilux S Fit Eyezen+ 4 Adaptar Digital varilux Ellipse varilux Physio Enhanced Fit varilux S 4D.

4 Essilor Computer Adaptar Short Digital varilux comfort DRx varilux comfort W2+ varilux X Design Essilor 360 Single Vision Essilor Natural Digital varilux comfort Short DRx varilux comfort W2+ Fit varilux X Fit Essilor Stylistic Single Essilor Ideal Advanced varilux comfort W2+ Eyecode varilux X4D. Vision Shamir Relax Essilor Ideal Advanced Wrap varilux Physio DRx Shamir Autograph III 11mm Shamir Autograph II+ . Ovation Digital varilux Physio Short DRx Shamir Autograph III 13mm Single Vision Shamir Autograph II+ . Shamir Intouch 15mm varilux Stylistic Shamir Autograph III 15mm Attitude Single Vision Kodak Digital Single Vision Shamir Intouch 18mm Kodak Unique Shamir Autograph III 18mm Kodak Precise PB Shamir Autograph II+ 11mm Shamir Autograph III Variable Kodak Precise Short PB Shamir Autograph II+ 13mm Shamir Autograph III Fashion 15mm Kodak Precise Shamir Autograph II+ 15mm Shamir Autograph III Fashion 18mm Shamir Spectrum+ 14mm Shamir Autograph II+ 18 mm Shamir Autograph III Sport Shamir Spectrum+ 16mm Shamir Autograph II+ Variable Shamir Autograph Intelligence 11mm Shamir Spectrum+ 18mm Shamir Autograph II+ Attitude 15mm Shamir Autograph Intelligence 13mm Shamir Autograph II+

5 Attitude 18mm Shamir Autograph Intelligence 15mm Shamir Autograph Intelligence 18mm Shamir Autograph Intelligence Variable Medicaid buy-up eligible Standard Premium Ultra Essilor Brillenz Essilor Ideal Advanced varilux Physio DRx Essilor Brillenz Short Essilor Ideal Advanced Wrap varilux Physio Short DRx Anti-reflective treatment: Commercial / Medicare Standard Premium Ultra Ultimate Sharpview+ Crizal Easy UV Crizal Aliz UV Crizal Avanc UV. Backside AR Crizal Sunshield UV Essilor Anti-Fog Crizal Sapphire 360 UV. Kodak CleAR Kodak Clean N CleAR Crizal Prevencia Kodak Total Blue Crizal Rock Medicaid buy-up eligible Standard Premium Ultra Standard ARC ClearShield ClearShield with UV.

6 Materials Clear Blue light filtering Photochromics Polarized Glass Plastic Essential Blue Series Transitions Signature GEN 8 Plastic Polarized Plastic Polycarbonate Essential Blue Series Transitions XTRA ctive Polycarbonate Polarized Polycarbonate Transitions Vantage Polarized Trivex Transitions Signature Style Colors Transitions XTRA ctive Style Mirrors Medicaid buy-up eligible Base Materials Photochromics Polarized Plastic Transitions Signature GEN 8* Plastic Polarized Polycarbonate Activations Polycarbonate Polarized Hi-Index Polarized * Ultra tier only ? Have any questions? Please contact our provider relations team for assistance. All trademarks are the property of their respective owners.

7 Last updated April 19, 2021.