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What You Should Know About
Your Vision Plan
If you
(or your family member) are enrolled in the Superior
Vision Care Plan, the following services
are covered by your insured benefit plan.
|
Benefits
|
In-Network
|
Out-of-Network
|
|
Comprehensive
Exam
by
Ophthalmologist (MD)
or Optometrist (OD) |
$35
Co-payment |
Up
to $42.00 |
|
Standard
Lenses (per pair)
Single Vision
Bifocal
Trifocal
Lenticular |
Covered
in Full
Covered in Full
Covered in Full
Covered in Full |
Up
to $32.00
Up to $46.00
Up to $61.00
Up to $84.00 |
|
Contact
Lenses (per pair)
Medically
Necessary
Cosmetic-Elective |
Covered
in Full
Up to $95.00 |
Up
to $210.00
Up to $95.00 |
|
Frames-Standard |
Up
to $140.00 |
Up
to $53.00 |
Discount
benefit
To
use the discount benefit you must present your ID card to the in-network
provider. This will verify your
eligibility (or your family member) as a Superior Vision Plan member.
Discounts are calculated from the providers standard retail prices.
Other discounts or coupons do not apply.
| Lens
upgrades and add-ons to your insured benefit. |
20%
Discount |
| Any
added cost to you over your C/L allowance |
10%
Discount |
| C/L
purchases in addition to your insured benefit |
10%
Discount |
| Additional
pairs of prescription lenses and frames. |
20%
Discount |
| Non-prescription
sunglasses. |
20%
Discount |
| Miscellaneous
items, such as eyeglass cases. |
20%
Discount |
Discounts
do not apply to your insured eyeframe benefit and are not applicable to the $95
contact lens allowance. Discounts
do not apply when prohibited from the manufacturer.
Important
Tips
-
Contact
lenses are covered in lieu of eyeglass lenses and frames benefit.
-
Comprehensive
exam, lenses, frames, and contact lenses are covered once a plan
year.
-
You
must go to a provider that is in the network unless you call the plan
administrator and receive prior approval to go to a non-network provider.
-
If
you go to a non-network provider, the benefit you receive will be less.
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