Vision Plan
Company employees can elect vision insurance for an extra cost through Superior Vision. The vision plan offers a national network of eye care professionals to serve all of your vision needs.
Note: Vision insurance can be elected separately from medical and dental coverage.
Vision Plan Overview
| Benefit | In-Network Provider | Out-of-Network Provider | ||
|---|---|---|---|---|
| Exams (Once per calendar year) | ||||
Exam Copay |
$10 | N/A | ||
Exam (Ophthalmologist) |
Covered in full after copay | Up to $44 retail | ||
Exam (Optometrist) |
Covered in full after copay | Up to $39 retail | ||
| Materials (Once per calendar year) | ||||
Co-Pay |
$25 | N/A | ||
| Frames | ||||
Frames |
$150 retail allowance | Up to $64 retail | ||
| Lenses (standard) per pair | ||||
Single Vision |
Covered in full after copay | Up to $34 retail | ||
Bifocal |
Covered in full after copay | Up to $48 retail | ||
Trifocal |
Covered in full after copay | Up to $64 retail | ||
Progressive Lens Upgrade |
See description | Up to $64 retail | ||
Polycarbonate for Child |
Covered in full after copay | Contact Supervision | ||
| Contact Lens (Once per calendar year) | ||||
Contact Lens Fitting Copay |
$35 | N/A | ||
Contact Lenses |
$150 retail allowance | Up to $100 retail | ||
Contact Lens Fitting (specialty) |
Plan pays 80%* after you/your dependent pay the deductible | Not covered | ||
Co-pay(s)s apply to in-network providers. Charges for out-of-network providers must be paid in full after visit with co-pays reimbursed.
- 1Materials co-pay applies to lenses and frames only, not contact lenses.
- 2See your benefits materials for definitions of standard and specialty contact lens fittings.
- 3Covered to provider’s in-office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co-pay.
- 4NOTE: The plan includes allowance for either contact lenses OR eyeglass frames.
