Page 13 - 2017-18 Centennial Benefits Guide Staff
P. 13
Vision Insurance
Vision coverage is with Aetna. Please see the following chart for a high-
level overview of the beneits.
Vision—Aetna
In-Network Out-of-Network
Eye exam $10 copay $25 reimbursement
Lenses
Single vision $10 copay $20 reimbursement
Bifocal $10 copay $40 reimbursement
Trifocal $10 copay $65 reimbursement
Lenticular $10 copay $65 reimbursement
Frames 1
$10 copay, maximum beneit of $150 1 $65 reimbursement
Contact Lenses 2
Elective Covered up to $150, $105 reimbursement
additional 15% over allowance
Necessary $0 copay $200 reimbursement
1 Any frame available, including frames for prescription sunglasses
2 In lieu of standard lenses and frames, above limits include evaluation and itting costs
Vision—Frequency
Exams 12 months
Lenses 12 months
Frames 24 months
Contact lenses 12 months
Centennial Contractors 13
Vision coverage is with Aetna. Please see the following chart for a high-
level overview of the beneits.
Vision—Aetna
In-Network Out-of-Network
Eye exam $10 copay $25 reimbursement
Lenses
Single vision $10 copay $20 reimbursement
Bifocal $10 copay $40 reimbursement
Trifocal $10 copay $65 reimbursement
Lenticular $10 copay $65 reimbursement
Frames 1
$10 copay, maximum beneit of $150 1 $65 reimbursement
Contact Lenses 2
Elective Covered up to $150, $105 reimbursement
additional 15% over allowance
Necessary $0 copay $200 reimbursement
1 Any frame available, including frames for prescription sunglasses
2 In lieu of standard lenses and frames, above limits include evaluation and itting costs
Vision—Frequency
Exams 12 months
Lenses 12 months
Frames 24 months
Contact lenses 12 months
Centennial Contractors 13
