2023 Wichita Public Schools Benefit Guide

Vision

Visit www.surency.com/vision to find an Insight Network Provider. Surency In-Network Plan Information Base Plan (Exam Only)

Buy Up Plan

Network

Insight Network

Out-of-Network

Insight Network

Out-of-Network

Exam

$0 Copay

$40

$0 Copay

$40

Exam Frequency

Once Per Calendar Year

Once Per Calendar Year

Lens Frequency

Unlimited

Once Per Calendar Year

Frames Frequency

Unlimited

Once Every Other Calendar Year

$150 Allowance, 20% Off Balance over $150

Standard Frames

35% Off Retail

N/A

$105

Lenses (Single, Bifocal, Trifocal)

$50 | $70 | $105

N/A

$25 Copay

$30 | $50 | $70

$150 Allowance, 15% Off Balance over $150

Conventional Contact Lenses

15% Off Retail

N/A

$120

Disposable Contact Lenses

Not Covered

N/A

$150 Allowance

$120

Medically Necessary Contact Lenses

Not Covered

N/A

100% Covered

$210

Base Plan (Exam Only)

Annually

Monthly

Bi-weekly (20)

Bi-weekly (26)

Employee Only

$0

$0

$0

$0

Employee + Spouse

$0

$0

$0

$0

Employee Child(ren)

$0

$0

$0

$0

Employee Family

$0

$0

$0

$0

Buy-Up Plan

Annually

Monthly

Bi-weekly (20)

Bi-weekly (26)

Employee Only

$49.68

$4.14

$2.49

$1.91

Employee + Spouse

$94.44

$7.87

$4.73

$3.64

Employee Child(ren)

$99.48

$8.29

$4.98

$3.83

Employee Family

$146.16

$12.18

$7.31

$5.63

20 - Employee Benefits Guide

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