Vision Coverage
The vision plan covers routine eye exams and also pays for all or a portion of the cost of glasses or contact lenses if you need them.
Your PPO vision plan is through Sun Life and offers “in and out-of-network” benefits.
To find an in-network provider, visit www.vsp.com/eye-doctor
Insurance Carrier:
Sun Life Vision Insurance
Plan Type:
In-Network
Out-of-Network
Exam Services
$10 $60
up to $30 up to $31 up to $25 up to $50 up to $60 up to $100
Contact Lens Exam Copay Lenses - Single lined Lenses - Bifocal lined Lenses - Trifocal lined Lenses - Lenticular lined
$10 Copay $10 Copay $10 Copay $10 Copay
$150 Retail Allowance; then 20% off remaining balance
Frames
up to $80
Elective Contact Lenses (in place of lenses & frames)
$150 Retail Allowance
up to $128
Medically Necessary Contacts
$10 Copay
up to $210
Frequency: Exam / Lenses / Frames
once every: 12 months / 12 months / 12 months
Employee Bi-Weekly Deduction Employee Only
$4.15 $8.09 $7.50
Employee + Spouse Employee + Child(ren)
Family
$11.43
10 Acom Integrated Solutions 2022 Enrollment Guide
Made with FlippingBook - professional solution for displaying marketing and sales documents online