Page 10 - 2015 BRP Benefits Guide
P. 10
Vision
Vision In-Network Out-of-Network
Eye doctors detect problems in Vision Exam $10 Up to $40 allowance
Exam Copay
vision, overall eye health, and detect Lenses
signs of other health conditions Single Lens $25 copay Up to $40 allowance
like diabetic eye disease, high blood Bifocal Lens (lined) $25 copay Up to $60 allowance
pressure, and high cholesterol. We Trifocal Lens (lined) $25 copay Up to $80 allowance
Up to $80 allowance
$25 copay
Lenticular Lens
know your eyesight is precious to Frames
you, so we provide vision beneits Frame Beneit Up to $130 allowance Up to $45 allowance
to make sure your trip to the eye Contact Lenses
doctor is reasonably priced. Elective Selection contacts, 6 Up to $150 allowance
boxes; non-selection
contacts, up to $150
There are no changes to our vision allowance
beneits in 2015. Vision coverage Medically Necessary $25 copay Up to $210 allowance
Frequency
will continue to be offered through Exams 12 months 12 months
UHC. Please review the additional Lens 12 months 12 months
details provided regarding the plan Contacts 12 months 12 months
design and cost of vision insurance (in lieu of glasses) 24 months 24 months
Frames
through BRP. Keep in mind the
information in the chart provided is Please refer to your Summary Plan Description (SPD) for complete details of plan beneits,
a summary only. limitations, and exclusions. In the event of a conlict between the SPD and this description, the
terms of the SPD will prevail.
Bi-Weekly Vision Coverage
Cost
Coverage Tier
Employee $3.69
Employee + Spouse $6.69
Employee + Child $6.69
Employee + Children $11.35
Employee + Family $11.35
BRP US Inc. 10
Vision In-Network Out-of-Network
Eye doctors detect problems in Vision Exam $10 Up to $40 allowance
Exam Copay
vision, overall eye health, and detect Lenses
signs of other health conditions Single Lens $25 copay Up to $40 allowance
like diabetic eye disease, high blood Bifocal Lens (lined) $25 copay Up to $60 allowance
pressure, and high cholesterol. We Trifocal Lens (lined) $25 copay Up to $80 allowance
Up to $80 allowance
$25 copay
Lenticular Lens
know your eyesight is precious to Frames
you, so we provide vision beneits Frame Beneit Up to $130 allowance Up to $45 allowance
to make sure your trip to the eye Contact Lenses
doctor is reasonably priced. Elective Selection contacts, 6 Up to $150 allowance
boxes; non-selection
contacts, up to $150
There are no changes to our vision allowance
beneits in 2015. Vision coverage Medically Necessary $25 copay Up to $210 allowance
Frequency
will continue to be offered through Exams 12 months 12 months
UHC. Please review the additional Lens 12 months 12 months
details provided regarding the plan Contacts 12 months 12 months
design and cost of vision insurance (in lieu of glasses) 24 months 24 months
Frames
through BRP. Keep in mind the
information in the chart provided is Please refer to your Summary Plan Description (SPD) for complete details of plan beneits,
a summary only. limitations, and exclusions. In the event of a conlict between the SPD and this description, the
terms of the SPD will prevail.
Bi-Weekly Vision Coverage
Cost
Coverage Tier
Employee $3.69
Employee + Spouse $6.69
Employee + Child $6.69
Employee + Children $11.35
Employee + Family $11.35
BRP US Inc. 10
