Page 12 - 2015 NISC Open Enrollment

Vision

NISC offers a vision plan administered through Guardian.

To ind a vision provider go to the NISC Beneit Portal and select the
NISC offers a vision plan Guardian doctor locator quick link. A highlight of the plan is shown in the
administered through following table.
Guardian.

Beneits Network Non-Network
Exam $20 copay $46 max after $20
copay
Standard Plastic Lenses
Guardian Vision Single Vision $20 copay $47 max after $20
To search for network vision copay
providers: Bifocal $20 copay $66 max after $20
copay
z www.guardiananytime.com Trifocal $20 copay $85 max after $20
z Select Find a Provider copay

z Select Find a Vision Provider Lenticular $20 copay $125 max after $20
copay
z Choose VSP from drop down Lens Options
box, enter zip code, select
VSP Network (Signature Plus), Scratch Resistant Coating 15-20% discount covered N/A
and click Continue Polycarbonate Lenses for 15-20% discount covered N/A
Kids
Frames
$20 copay; $120 retail $47 max after $20
max; additional 20% copay
discount over the max
Contact Lenses
Elective $20 copay; $120 retail $120 max, after $20
max; additional 20% copay
discount over the max
Medically Necessary $0 copay $210 max after $20
copay
Frequency
Exams, Lenses, Contact Once every 12 months
Lenses (in lieu of glasses)
Frames Once every 24 months

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