KCA - 2018 Plan Year

VISION INSURANCE

Kisinger Campo & Associates offers vision coverage through Superior Vision. The Superior Vision plan allows you the flexibility to see any provider. To search in-network providers visit www.Superiorvision.com and in search based on your location in the “Locate a Provider” box. You will be asked to select your network, please select “Superior National”. When you utilize an out-of-network provider you pay expenses at the time of service and file a claim for reimbursement. Below is a list of the reimbursement schedule.

Vision Superior National Network

In-Network

Routine Eye Exams

Every 12 months

$10 Copay

Lenses 2

Every 12 months

Single Vision Bifocal Trifocal

$10 Copay Factory scratch coating is covered 100% Lens upgrades are available at 20% of retail pricing.

Ultraviolet coat Tints, solid or gradients Anti-reflective coat

$15 Copay $25 Copay $50 Copay

Polycarbonate High index 1.6 Photochromics

$40 Copay for single vision / 20% off retail for bifocal & trifocal $55 Copay for single vision / 20% off retail for bifocal & trifocal $80 Copay for single vision / 20% off retail for bifocal & trifocal

Frames

Every 24 months

$10 Copay provides a $150 allowance PLUS 20% off cost over the allowance allowance

Contact Lenses (in lieu of glasses) 1

Every 12 months

Elective Contact Lenses Contact Lens Fitting 2

$150allowance

Standard Specialty

Covered in full $50 allowance

Out-of-Network

Routine Eye Exams

Every 12 months Reimbursed up to $28-33 Every 12 months Reimbursed up to $28 Reimbursed up to $40 Reimbursed up to $53 Reimbursed up to $53 Every 24 months Reimbursed up to $70 Every 12 months Reimbursed up to $100 Reimbursed up to $100

Lenses 2 Single

Bifocal Trifocal Progressives

Frames

Contact Lenses (in lieu of glasses) Elective Medically Necessary

Bi-Weekly Cost for Coverage

Employee Only

$3.99

Employee + Spouse

$7.49

Employee + Child(ren)

$7.85

1 Reimbursable amount, less applicable copay.

Employee + Family

$11.86

1 Lenses benefit listed are for a pair of lenses 2 Standard Contact Lens Fitting applies to a current contact lens user who wears disposable, daily wear, or extended wear lenses only. Specialty Contact Lens Fitting applies to new contact wearers and/or a member who wear toric, gas permeable, or multi-focal lenses.

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