Page 13 - EMSAR 2022 Benefits Guide
P. 13
2022
Benefits Guide
Vision Insurance
Reliance Standard | Group Number:
421106
Regular eye examinations cannot only determine
your need for corrective eyewear but also detect
general health problems in their earliest stages.
Protection for the eyes should be a major concern to
everyone.
In-Network Beneits Vision Plan
Network Name VSP Choice Network
Wellness Eye Exam $10 copay
Frequency (Exam/Lenses/Frames/ 12/12/12
Contact Lenses)
Materials Beneit
Lenses $25 copay
Frames $130 allowance
Contact Lenses (in lieu of Lenses & $130 allowance
Frames)
Out-of-Network Beneits
Out-of-Network Reimbursement Up to $30/$50/$65/$100
Please see summary of beneits for more detailed information.
Payroll Deduction
Per Pay Period (26)
Associate Only $2.54
Associate & Spouse $4.81
Associate & Children $5.64
Associate & Family $7.93
13
Benefits Guide
Vision Insurance
Reliance Standard | Group Number:
421106
Regular eye examinations cannot only determine
your need for corrective eyewear but also detect
general health problems in their earliest stages.
Protection for the eyes should be a major concern to
everyone.
In-Network Beneits Vision Plan
Network Name VSP Choice Network
Wellness Eye Exam $10 copay
Frequency (Exam/Lenses/Frames/ 12/12/12
Contact Lenses)
Materials Beneit
Lenses $25 copay
Frames $130 allowance
Contact Lenses (in lieu of Lenses & $130 allowance
Frames)
Out-of-Network Beneits
Out-of-Network Reimbursement Up to $30/$50/$65/$100
Please see summary of beneits for more detailed information.
Payroll Deduction
Per Pay Period (26)
Associate Only $2.54
Associate & Spouse $4.81
Associate & Children $5.64
Associate & Family $7.93
13
