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. You may elect vision care coverage, which provides affordable, quality vision care nationwide. 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.
Plan Information
Plan Name: XXXX
Policy Number: #XXXX
Effective Date: XX/XX/XXXX
Network: XXXX
Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
In-Network
Exams
$XX
Single Vision Lenses
$XX
Bifocal Lenses
$XX
Trifocal Lenses
$XX
Frames
$XX
Contacts (in lieu of glasses)
$XX
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
$XX
Single Vision Lenses
$XX
Bifocal Lenses
$XX
Trifocal Lenses
$XX
Frames
$XX
Contacts (in lieu of glasses)
$XX
Frequency
Exams
Once every 12 months
Lenses
Once every 12 months
Frames
Once every 24 months
Contacts
Once every 12 months