VISION INSURANCE
Pavement Restoration offers vision coverage through Mutual of Omaha. The Vision Plan allows you to use in-network (EyeMed Providers) or out-of-network benefits. If out-of-network vision providers are used, you will be responsible for pay the difference between Mutual of Omaha’s allowed amount and what the provider may charge, also known as “balance billing”.
Vision
Routine Eye Exams
$10 Copay
Lenses* Single
$25 Copay $25 Copay $25 Copay $25 Copay
Bifocal Trifocal Lenticular
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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