Pavement Restoration 2019

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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