VISION INSURANCE
Palmetto Prime offers vision coverage through Guardian. The Vision PPO Plan allows you to use in-network or out-of- network benefits. If out-of-network vision providers are used, you will be responsible for pay the difference between Guardian’s allowed amount and what the provider may charge, also known as “balance billing”.
Vision
Routine Eye Exams
$10 Copay
Lenses*
Single Bifocal Trifocal Lenticular
$25 Copay $25 Copay $25 Copay $25 Copay
Frames
$100 allowance, less applicable copay
Contact Lenses
$100 allowance, less applicable copay
Frequency Exam
Once every 12 months
Lenses or contact lenses
Once every 12 months
Frame
Once every 24 months
• Lenses, Frames & Contacts are limited to either one pair of contacts or frames/lenses per calendar year .
Employee Contributions (Weekly)
Vision
Employee Only
$1.51 $2.54 $2.59 $4.10
Employee + Spouse
Employee + Child(ren)
Family
6
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