2018 Bridging Freedom Benefits at a Glance

VISION INSURANCE

Bridging Freedom 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 paying the difference between Guardian’s allowed amount and what the provider may charge, also known as “balance billing”.

Vision

In-Network

Out-of-Network

Eye Exam

Every 12 months

$10 Copay

Up to $50

Lenses**

Every 12 months

Single Vision

$25 Copay

Up to $48

Bifocal Lenses

$25 Copay

Up to $67

Trifocal Lenses

$25 Copay

Up to $86

Lenticular Lenses

$25 Copay

Up to $126

Frames

Every 24 months

Up to $130 + 20% off overage

Up to $48

Contact Lenses

Every 12 months

Elective

Up to $130 + 15% off overage

Up to $105

Medically Necessary

Covered 100%

Up to $210

** Lenses, Frames & Contacts are limited to either one pair of contacts or frames/lenses per calendar year.

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