Page 12 - Guide
P. 12
2017 Benefits Enrollment
Vision
Voluntary Vision
The company will continue to offer voluntary vision coverage through
Vision Beneits of America (VBA). There will be a slight enhancement
to the contact lens beneit. To ind an in-network vision provider, visit
www.vbaplans.com. There is an individual two year commitment if you
elect vision coverage.
All VBA participating providers will be able to process claims
electronically. If a member chooses to use a non-participating provider,
an out-of-network reimbursement form is available on the website,
www.vbaplans.com.
Monthly Voluntary Vision Contribution
Employee $4.05
Employee + One Dependent $7.35
Employee + Family $9.95
Vision Beneits of America
In-Network Out-of-Network
Exam
$0 copay Up to $40 reimbursement
Lenses
Single $20 copay Up to $40 reimbursement
Bifocal $20 copay Up to $50 reimbursement
Trifocal $20 copay Up to $75 reimbursement
Lenticular $20 copay Up to $100 reimbursement
Frames
Covered at 100% after a Up to $50 reimbursement
$20 copay, when within
the plan’s $50 wholesale
allowance (approximately
$125 to $150 retail)
Contacts (in lieu of glasses)
Elective Contact Lenses Material allowance: $110 Up to $110 reimbursement
allowance
Fitting fee: 15% discount
off Usual, Customary, and
Reasonable, as determined
by VBA
Medically Necessary Covered at 100%, once Up to $300 reimbursement
(requires prior approved by VBA
authorization from VBA)
Frequency
Exam, Lenses, or Contacts 12 months
Frames 24 months
12
Vision
Voluntary Vision
The company will continue to offer voluntary vision coverage through
Vision Beneits of America (VBA). There will be a slight enhancement
to the contact lens beneit. To ind an in-network vision provider, visit
www.vbaplans.com. There is an individual two year commitment if you
elect vision coverage.
All VBA participating providers will be able to process claims
electronically. If a member chooses to use a non-participating provider,
an out-of-network reimbursement form is available on the website,
www.vbaplans.com.
Monthly Voluntary Vision Contribution
Employee $4.05
Employee + One Dependent $7.35
Employee + Family $9.95
Vision Beneits of America
In-Network Out-of-Network
Exam
$0 copay Up to $40 reimbursement
Lenses
Single $20 copay Up to $40 reimbursement
Bifocal $20 copay Up to $50 reimbursement
Trifocal $20 copay Up to $75 reimbursement
Lenticular $20 copay Up to $100 reimbursement
Frames
Covered at 100% after a Up to $50 reimbursement
$20 copay, when within
the plan’s $50 wholesale
allowance (approximately
$125 to $150 retail)
Contacts (in lieu of glasses)
Elective Contact Lenses Material allowance: $110 Up to $110 reimbursement
allowance
Fitting fee: 15% discount
off Usual, Customary, and
Reasonable, as determined
by VBA
Medically Necessary Covered at 100%, once Up to $300 reimbursement
(requires prior approved by VBA
authorization from VBA)
Frequency
Exam, Lenses, or Contacts 12 months
Frames 24 months
12
