Page 13 - 2017 FutureSteps

Vision

There are no changes to the vision plan in 2017 Future Steps . Having healthy
eyesight is another important component of your overall health. The Superior
Vision plan helps you pay for eye exams, eyeglasses (lenses and frames)
and contact lenses. The plan includes both in-network and out-of-network
beneits. Please review the vision beneit summary for more information.
Please remember, with Superior Vision, an insurance card is not required.
Let the provider know your insurance is through Superior Vision, provide your
name and SS#, and they will verify your coverage.

In-Network Out-of-Network
Eye exam $20 copay Ophthalmologist: up to
(every 12 months) $42
Optometrist:
Up to $37
Materials $20 copay N/A
Lenses (every 12 months)
Single vision Covered under materials copay Up to $32
Bifocal Covered under materials copay Up to $46
Trifocal Covered under materials copay Up to $61
Lenticular Covered under materials copay Up to $84
Frames (every 24 months)
$150 retail allowance, then 20% Up to $68
discount
Contact Lenses (every 12 months)
1
Elective $150 retail allowance Up to $100
Medically necessary Covered in full Up to $210
1 In lieu of eyeglass lenses and frames beneit

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