Page 15 - Benefits Guide
P. 15
Vision Coverage
Because symptoms of health conditions often don’t appear until damage
has already occurred, eye exams are a great way to keep tabs on what’s
happening in your body. Your eyes are the only place in your body
which provide a clear view of your blood vessels, arteries, and a cranial
nerve which can tell your doctor a lot about your overall health. Our
vision insurance coverage, offered in partnership with National Vision
Administrators, is designed to meet a variety of needs.
Find an In-Network Provider
Remember to visit in-network providers to receive the deepest level of
discount on your services. To ind a participating in-network provider in
your area go to www.e-nva.com.
National Vision Administrators
In-Network Out-of-Network
Copay
Exam $10 $45 allowance
Materials $25 See below
Lenses
Single $25 copay $40 allowance
Bifocal $25 copay $60 allowance
Trifocal $25 copay $80 allowance
Lenticular $25 copay $100 allowance
Frames
$130 allowance and 20% $70 allowance
discount on any balance
over $130
Contacts
Elective $125 allowance and 10- $125 allowance
15% off remaining balance
Non-Elective Covered 100% $210 allowance
Frequency
Exam 12 months
Lenses 12 months Pre-Tax
Contacts (in lieu of lenses) 12 months Bi-Weekly
Frames 24 months Contributions
Employee $2 .60
This is a high level summary of your beneit coverage. Full coverage details are available in your Employee and Spouse $4 .92
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 and $5 .77
Child(ren)
Family $8 .12
myNEXUS 15
Because symptoms of health conditions often don’t appear until damage
has already occurred, eye exams are a great way to keep tabs on what’s
happening in your body. Your eyes are the only place in your body
which provide a clear view of your blood vessels, arteries, and a cranial
nerve which can tell your doctor a lot about your overall health. Our
vision insurance coverage, offered in partnership with National Vision
Administrators, is designed to meet a variety of needs.
Find an In-Network Provider
Remember to visit in-network providers to receive the deepest level of
discount on your services. To ind a participating in-network provider in
your area go to www.e-nva.com.
National Vision Administrators
In-Network Out-of-Network
Copay
Exam $10 $45 allowance
Materials $25 See below
Lenses
Single $25 copay $40 allowance
Bifocal $25 copay $60 allowance
Trifocal $25 copay $80 allowance
Lenticular $25 copay $100 allowance
Frames
$130 allowance and 20% $70 allowance
discount on any balance
over $130
Contacts
Elective $125 allowance and 10- $125 allowance
15% off remaining balance
Non-Elective Covered 100% $210 allowance
Frequency
Exam 12 months
Lenses 12 months Pre-Tax
Contacts (in lieu of lenses) 12 months Bi-Weekly
Frames 24 months Contributions
Employee $2 .60
This is a high level summary of your beneit coverage. Full coverage details are available in your Employee and Spouse $4 .92
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 and $5 .77
Child(ren)
Family $8 .12
myNEXUS 15
