Page 11 - NextCare Holdings 2021 Annual Benefits Enrollment

2021
NextCare Holdings Benefits Enrollment

Vision

NextCare offers vision insurance through Delta
Dental of Arizona using the EyeMed network. You
will receive an ID card in the mail after enrollment.

In-Network Out-of-Network
Exam $10 copay Up to $30
(every 12 months) reimbursement
Single Lenses $10 copay Up to $25
(every 12 months) reimbursement
Bifocal Lenses $10 copay Up to $40
(every 12 months) reimbursement
Trifocal Lenses $10 copay Up to $55
(every 12 months) reimbursement
Lenticular Lenses $10 copay Up to $55
(every 12 months) reimbursement
Frames $150 allowance, Up to $75
(every 12 months) plus 20% of reimbursement
amount over
allowance
Elective Contacts Conventional: Up to $120
(every 12 months $150 allowance, reimbursement
in lieu of glasses) plus 15% of
balance over $150

Disposable: $0
copay; $150
allowance, plus
balance over $150

Employee Vision Cost Per Pay Period

Employee Only $3 .76
Employee and Spouse $6 .01
Employee and Child(ren) $6 .14
Family $9 .90

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