Vision
Healthy eyes and clear vision are an important part of your overall health and quality of life. You may enroll yourself and your eligible dependents or you may waive vision coverage. You do not have to be enrolled in medical coverage to elect vision coverage or cover the same dependents under medical and vision.
Although vision care services and supplies are covered in-network and out-of-network, your benefits are generally greater when you use in-network providers. Your costs are based on the family members you choose to cover.
Vision Low Plan
Benefit Highlights
In-Network
Exams
$10
Materials
$25
Single Vision Lenses
$0 after materials copay
Bifocal Lenses
$0 after materials copay
Trifocal Lenses
$0 after materials copay
Frames
Balance over $130 allowance
Contacts (in lieu of glasses)
Balance over $130 allowance
Frequency
Exams
Once every 12 months
Lenses
Once every 12 months
Frames
Once every 24 months
Contacts
Once every 12 months
Out-of-Network Reimbursement
Exams
$10
Materials
$25
Single Vision Lenses
Up to $40 reimbursement
Bifocal Lenses
Up to $60 reimbursement
Trifocal Lenses
Up to $80 reimbursement
Frames
Up to $45 reimbursement
Contacts (in lieu of glasses)
Up to $210 reimbursement
Up to $105 reimbursement
Frequency
Exams
Once every 12 months
Lenses
Once every 12 months
Frames
Once every 24 months
Contacts
Once every 12 months
Plan Cost
Employee Only: $XX
Employee and Spouse: $XX
Employee and Child(ren): $XX
Employee and Family: $XX
Vision High Plan
Benefit Highlights
In-Network
Exams
$10
Materials
$10
Single Vision Lenses
$0 after materials copay
Bifocal Lenses
$0 after materials copay
Trifocal Lenses
$0 after materials copay
Frames
Balance over $180 allowance
Contacts (in lieu of glasses)
Balance over $200 allowance
Frequency
Exams
Once every 12 months
Lenses
Once every 12 months
Frames
Once every 24 months
Contacts
Once every 12 months
Out-of-Network Reimbursement
Exams
$10
Materials
$10
Single Vision Lenses
Up to $40 reimbursement
Bifocal Lenses
Up to $60 reimbursement
Trifocal Lenses
Up to $80 reimbursement
Frames
Up to $45 reimbursement
Contacts (in lieu of glasses)
Up to $175 reimbursement
Frequency
Exams
Once every 12 months
Lenses
Once every 12 months
Frames
Once every 24 months
Contacts
Once every 12 months
Plan Cost
Employee Only: $XX
Employee and Spouse: $XX
Employee and Child(ren): $XX
Employee and Family: $XX