Benefits for 2023
Vision Coverage
SUMMARY OF COVERAGE
Guardian
Network
PPO
Frequency of Service Exam
every 12 months every 12 months every 12 months every 12 months
Materials
Lenses /Contacts
Frames
Exam
$10copay $25copay
Materials Benefits EyeExam
In-Network
Out-of-Network
100%
up to$40
$150 max + 20% off balance
Frames
up to$45
Lenses – Single Lenses – Bifocal Lenses – Trifocal Lenses – Lenticular
100% 100% 100% 100% 100%
up to$40 up to$60 up to$80 up to$80 up to$210
Lenses - Contact(necessary) Lenses - Contact(elective)
Up to $150maximum up to $150
Lasik
Discounts available
n/a
Available for employees working 20+ hours/week * For illustrative purposes only. Please refer to your plan documents for all plan details
This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.
2023 Employee Benefit Guide
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