VISION INSURANCE
VISION PLAN INFORMATION
65%+ FTE FACULTY 75%+ FTE STAFF
ELIGIBILITY
PLAN INFORMATION
VISION CARE SERVICES
In Network Member Cost
Out of Network Reimbursement
$25 Copay $150 Frame Allowance 20% Off Balance Over Allowance $80 Walmart®/Sam’s Club®/Costco® Frame Allowance
FRAMES (EVERY OTHER CALENDAR YEAR)
Up To $70
SINGLE VISION BIFOCAL TRIFOCAL IMPACT-RESISTANT LENSES FOR DEPENDENT CHILDREN CONTACT LENSES (IN LIEU OF GLASSES)
Up to $30 Up to $50 Up to $65 Up to $50
Included In Rx Glasses Co-Pay
$60 Copay $130 Contact Allowance
Up to $105
EYE EXAM
Eye Exams Are Covered Under Medical Insurance
$3.33 Employee Only $7.14 Employee + Child(Ren) $6.66 Employee + Spouse $11.41 Employee +Family
EMPLOYEE CONTRIBUTION
PLAN ADMINISTRATOR
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