Page 9 - Sample Guide
P. 9
Lockton collateral, not for leave behind or distribution. 2019
Benefits Enrollment
VISION Finding In-Network
We partner with [Carrier] to offer you and your family members vision Providers
insurance. Visit www.[Carrier].com to ind in-network providers and Remember to visit in-network
access to a variety of online tools and programs. dentists to receive the deepest
level of discount on your services.
In-Network Out-of-Network
Copay To ind a participating in-
Exam network provider in your area
go to [website.com] or call
Materials [555 .555 .5555] .
Lenses
Single
Bifocal
Trifocal
Lenticular
Frames
Contacts
Frequency
Exam
Lenses
Contacts (in lieu of
glasses)
Frames
This is a high level summary of your beneit coverage. Full coverage details are available in your
summary plan description (SPD). In the event there is a discrepancy between what is relected in
this guide and what is communicated in your SPD, the terms of your SPD will prevail.
Employee [Monthly/Weekly/Bi-Weekly] Vision
Contributions
Employee Only $
Employee and Spouse $
Employee and Child(ren) $
Family $
9
VISION Finding In-Network
We partner with [Carrier] to offer you and your family members vision Providers
insurance. Visit www.[Carrier].com to ind in-network providers and Remember to visit in-network
access to a variety of online tools and programs. dentists to receive the deepest
level of discount on your services.
In-Network Out-of-Network
Copay To ind a participating in-
Exam network provider in your area
go to [website.com] or call
Materials [555 .555 .5555] .
Lenses
Single
Bifocal
Trifocal
Lenticular
Frames
Contacts
Frequency
Exam
Lenses
Contacts (in lieu of
glasses)
Frames
This is a high level summary of your beneit coverage. Full coverage details are available in your
summary plan description (SPD). In the event there is a discrepancy between what is relected in
this guide and what is communicated in your SPD, the terms of your SPD will prevail.
Employee [Monthly/Weekly/Bi-Weekly] Vision
Contributions
Employee Only $
Employee and Spouse $
Employee and Child(ren) $
Family $
9
