Vision Plan Summary
Employees may elect vision coverage through Superior Vision . The plans pay benefits for annual exams and corrective lenses . There are co-pays for exams and materials , and the plan pays for frames and lenses up to certain limits . Under this plan , members may use in-network or out-of-network vision care providers . Some benefits are only available from in-network providers . The Superior Vision National Network offers the flexibility of choice to keep out-of-pocket costs low — members may opt to get the exam and materials at one location or get the exam at one location and the materials at another location .
Superior Vision Plan National Network
Exam with an Ophthalmologist ( every 12 months )
Exam with an Optometrist ( every 12 months )
Standard Lenses ( every 12 months )
Low Plan
High Plan In-Network Out-of-Network In-Network Out-of-Network
Co-Pays : Exam $ 10 then covered in full
Co-Pays : Exam $ 10 then covered in full
Co-Pays : $ 10 materials . Single , Bifocal , Trifocal and ( Polycarbonate for dependents under age 18 ) covered in full .
Standard Frames Every 24-Months . $ 130 retail allowance
Contact Lens Fitting ( CLF ) ( once every 12 months )
Co-Pays : Exam $ 10 Up to $ 42
Co-Pays : Exam $ 10 then covered in full
Up to $ 37 retail Co-Pays : Exam $ 10 then covered in full
Single up to $ 32 . Bifocal up to $ 46 . Trifocal up to $ 61 Polycarbonate - not covered .
Every 24-Months . Up to $ 68 retail
Co-Pays : $ 10 materials . Single , Bifocal , Trifocal and ( Polycarbonate for dependents under age 18 ) covered in full .
Every 12-Months . $ 140 retail allowance
Co-Pays : Exam $ 10 Up to $ 42
Up to $ 37 retail
Single up to $ 32 . Bifocal up to $ 46 . Trifocal up to $ 61 Polycarbonate - not covered .
Every 12-Months . Up to $ 68 retail
* This comparison is a basic summary only . Refer to the Superior Vision schedule of benefits on the HR Portal , Portal under Documents and Forms , Category : Vision .
Vision coverage terminates the last day of the month in which you are no longer eligible for benefits . Contact Lenses ( in lieu of eyeglasses once every 12 mos )
Refractive Eye Surgery for Lasik SuperiorVision . com
Co-Pay $ 5 , then covered in full . Specialty CLF up to $ 50 allowance .
$ 120 retail allowance .
Discount at participating providers .
Not covered Co-Pay $ 0 Covered in full . Specialty CLF up to $ 50 allowance .
Up to $ 100
N / A
$ 130 retail allowance .
Discount at participating providers .
Not covered
Up to $ 100
N / A
Choose Video 1 for the Low Plan , or Video 2 for the High Plan .
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