Page 11 - TVS New Hire Guide

2020
TVS SCS NA New Hire Guide

VOLUNTARY VISION To view your weekly

Voluntary Vision vision contribution

Vision insurance is through Guardian. Please see below for a high level rates, please visit
description of the plan. More detailed beneit summaries are available the enrollment
through Human Resources. website .

Guardian OAP Out-of-Network
Copay
Exam $10 copay $50 max beneit after $10 copay

Materials $25 copay Varies after $25 copay
Lenses
Single $25 copay $48 max beneit after $25 copay

Bifocal $25 copay $67 max beneit after $25 copay
Trifocal $25 copay $86 max beneit after $25 copay
Frames Plan will pay $135 retail $48 max beneit after $25 copay
after $25 copay
Contacts—Elective
Formulary $25 copay $105 max beneit after $25 copay
Non-Formulary $135 max
(copay waived)
Medically Necessary $25 copay $210 max beneit after $25 copay
Frequency
Exam 12 months
Lenses 12 months
Contacts 12 months
(in lieu of glasses)
Frames 24 months

Vision Provider Search

1. Go to www.guardiananytime.com
2. Click on “Find a Provider” on the top right

3. Click on “Find a Vision Provider”
4. Select the “Davis Vision” Network

5. Enter search criteria
6. Click on “Continue” to view results

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