Acom - 2024 Benefits Guide - Class 2 - All Eligible Employe…

Vision Coverage

You can help protect your eyesight by visiting an eye doctor regularly. Vision insurance includes an annual comprehensive eye exam with an eye care doctor. Taking care of your eyes today can lead to a better quality of life later. Seeing an in-network eye care provider can reduce your expenses with savings on frames, lenses, contacts, eye exams and more.

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

$4.24 $8.25 $7.64

Employee + Spouse Employee + Child(ren)

Family

$11.66

12 ACOM INTEGRATED SOLUTIONS 2024 BENEFITS GUIDE

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