~Dual Comp Staff Provider Onboarding Binder 06.26.20

VISION INSURANCE

VISION PLAN INFORMATION

65%+ FTE FACULTY 75%+ FTE STAFF

ELIGIBILITY

VISION CARE SERVICES

PLAN INFORMATION

IN NETWORK MEMBER COST

OUT OF NETWORK REIMBURSEMENT

$25 COPAY; $130-$150 ALLOWANCE; 20% OFF BALANCE OVER ALLOWANCE; $70 COSTCO FRAME ALLOWANCE INCLUDED IN RX GLASSES CO-PAY INCLUDED IN RX GLASSES CO-PAY INCLUDED IN RX GLASSES CO-PAY $55-$175 CO-PAY

FRAMES (EVERY OTHER CALENDAR YEAR)

UP TO $70

SINGLE VISION BIFOCAL TRIFOCAL STANDARD PROGRESSIVE LENSES

UP TO $30 UP TO $50 UP TO $65 UP TO $50

CONTACT LENS FIT AND EVALUATION

UP TO $60

NOT APPLICABLE

CONTACT LENSES (IN LIEU OF GLASSES)

$60 COPAY

UP TO $105

$3.82 EMPLOYEE ONLY

$8.18 EMPLOYEE + CHILD(REN)

EMPLOYEE CONTRIBUTION

$13.08 EMPLOYEE + FAMILY

$7.74 EMPLOYEE + SPOUSE

PLAN ADMINISTRATOR

VSP

FOR MORE INFORMATION ON VISION BENEFITS: http://www.uc.edu/hr/benefits/healthplans/vision.html

Additional Insurance 3

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