VISION PLAN
LIFE & DISABILITY
Vision Plan Through Delta Dental of WI
Life & AD&D Through Sun Life
DeltaVision, in partnership with EyeMed’s Insight network, is one of the nation’s largest vision care provider networks with more than 26,300 locations nationwide.
Wolter provides benefit eligible employees with group life & accidental death & dismemberment (AD&D) insurance, & pays the cost of this benefit. Employees who want to supplement their group life insurance benefits may purchase additional coverage. When you enroll yourself and/or your dependents in this benefit, you pay the full cost through payroll deductions.
Participating Provider
Non-Participating Provider
Basic Life / AD&D
Disability Insurance Through Sun Life
Services / Material
Frequency
Basic Life Benefit
Flat $50,000 Flat $50,000
Exam
Paid in full
Up to $35 retail value Once every 12 months
Wolter provides benefit eligible employees with voluntary short & long-term disability income benefits. In the event you become disabled from a non work-related injury or sickness, disability income benefits are provided as a source of income.
AD&D Benefit
Retail allowance of $150, then 20% off balance
Frames
Up to $75 retail value Once every 24 months
Voluntary Life / AD&D
Lenses Single Vision
Employee
Up to $500,000 in $10,000 increments, not to exceed 5X basic annual earnings ▶ Guarantee Issue: $150,000 Up to $250,000 in $5,000 increments, not to exceed 100% of the employee’s amount ▶ Guarantee Issue: $50,000 $2,000 / $4,000 / $6,000 / $8,000 / $10,000 ▶ Guarantee Issue: N/A
Paid in full Paid in full Paid in full
Up to $25 retail value Up to $40 retail value Up to $55 retail value Up to $40 retail value
Bifocal
Voluntary-Short Term Disability Benefits Begin - Accident
Once every 12 months
Trifocals
8th Day 8th Day 12 weeks
Progressive
Members pay $75
Benefits Begin - Illness
Contact Lenses Conventional
Spouse
Benefits Duration
Contact allowance of $150, then 15% off balance
Up to $120 retail value
Percentage of Income Replaced 60% Weekly Maximum Benefit
Once every 12 months
Disposable
$150 allowance
Up to $120 retail value
$750 / week
Medically Necessary
Paid in full
$200
LASIK
15% off retail price or 5% off promotional price
Voluntary-Long Term Disability
Child (to age 26)
DEDUCIBLE: Exam $10 | Materials $10
Elimination Period Benefits Duration
90 Days SSNRA
Reduction Schedule
33% at age 70, 50% at age 75
Own Occupation Period 2 Years Percentage of Income Replaced 60% Maximum Benefit
Tier
Vision Monthly Premiums
Accelerated Life Benefit 12 month life expectancy, 75% to a maximum of $500,000 Waiver of Premium Included
$5,000 / Month
$7.04 $14.08 $14.37 $21.41
Employee Only
Social Security Integration
Full Family 3 Months 24 Months
EMPLOYEE PREMIUMS Your monthly vision payroll deductions before taxes.
Employee + Spouse Employee + Child(ren)
Survivor Benefit
Conversion Portability
Mental/Nervous/Drug/Alcohol
Family
Pre-existing Conditions
12 / 12
LIFE / AD&D / DISABILITY / WOLTER / / 9
8 / / WOLTER / VISION PLAN
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