Page 11 - Enrollment Guide Example

Vision

Vision Benefits

Your eyes are the only place in your body that can provide a clear view of
your blood vessels, arteries, and a cranial nerve which can tell your doctor
a lot about your overall health. That is why [Client Name] partners with

[Carrier] to offer you vision insurance. The 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. To locate an in-
network provider, visit www.[Carrier].com.

Vision Beneits At-a-Glance
In-Network
Exams Covered in full, after $20 copayment
(every 12 months)
Lenses (every 12 months)
Single Combined with exam
Bifocal Combined with exam
Trifocal Combined with exam
Polycarbonate lenses Combined with exam
for dependent children
Approved Frames (every 24 months)
$130 allowance
Approved Contact Lenses (every 12 months) in lieu of glasses
Elective Up to a $60 copayment

Vision

Bi-weekly
Employee only $
Employee and spouse $
Employee and child(ren) $
Employee and family $

11