Page 15 - Dealer Tire 2022 Benefits Guide
P. 15
2022 Benefits Guide
Vision
We partner with VSP to ofer you and your family Associate Bi-Weekly Vision
members vision insurance. Visit www.vsp.com to Contributions
ind in-network providers and access to a variety of
online tools and programs. Vision Plan—Bi-Weekly
Associate Only $3.95
VSP Associate and Spouse $5.72
In-Network Associate and Child(ren) $6.80
Copays Family $10.87
Exam $10
Materials $25
Frames Finding In-Network Providers
Frames Allowance $175
Featured Frames Allowance $195 Remember to visit in-network dentists to receive the deepest
(check out vsp.com/ofers) level of discount on your services.
Frequency Limitations Every 12 months
Lenses To ind a participating in-network provider in your area, go to
Single Vision, Lined Bifocal, Copay included in materials www.vsp.com or call 800.877.7195.
and Lined Trifocal
Anti-glare Coating $0 copay
Tints/Light-reactive $0 copay
Standard Progressive Lenses $0 copay
Premium Progressive Lenses $95-$105
Custom Progressive Lenses $150-$175
Frequency Limitations Every 12 months
Contacts (instead of glasses)
Contacts Allowance $175
Contact Lens Exam (itting and Up to $60
evaluation)
Frequency Limitations Every 12 months
Out-of-Network Beneits
Exam Up to $45
Frame Up to $70
Single Vision Lenses Up to $30
Lined Bifocal Lenses Up to $50
Lined Trifocal Lenses Up to $65
Progressive Lenses Up to $50
Contacts Up to $105
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.
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Vision
We partner with VSP to ofer you and your family Associate Bi-Weekly Vision
members vision insurance. Visit www.vsp.com to Contributions
ind in-network providers and access to a variety of
online tools and programs. Vision Plan—Bi-Weekly
Associate Only $3.95
VSP Associate and Spouse $5.72
In-Network Associate and Child(ren) $6.80
Copays Family $10.87
Exam $10
Materials $25
Frames Finding In-Network Providers
Frames Allowance $175
Featured Frames Allowance $195 Remember to visit in-network dentists to receive the deepest
(check out vsp.com/ofers) level of discount on your services.
Frequency Limitations Every 12 months
Lenses To ind a participating in-network provider in your area, go to
Single Vision, Lined Bifocal, Copay included in materials www.vsp.com or call 800.877.7195.
and Lined Trifocal
Anti-glare Coating $0 copay
Tints/Light-reactive $0 copay
Standard Progressive Lenses $0 copay
Premium Progressive Lenses $95-$105
Custom Progressive Lenses $150-$175
Frequency Limitations Every 12 months
Contacts (instead of glasses)
Contacts Allowance $175
Contact Lens Exam (itting and Up to $60
evaluation)
Frequency Limitations Every 12 months
Out-of-Network Beneits
Exam Up to $45
Frame Up to $70
Single Vision Lenses Up to $30
Lined Bifocal Lenses Up to $50
Lined Trifocal Lenses Up to $65
Progressive Lenses Up to $50
Contacts Up to $105
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.
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