Page 14 - Dent Wizard 2021 Annual Benefits Enrollment
P. 14
Vision
We partner with VSP to offer you and your family members vision insurance. Visit www.vsp.com to ind in-
network providers and access to a variety of online tools and programs.
VSP
In-Network
Copays
Exam $10
Materials $25
Frames
Frames Allowance $175
Featured Frames Allowance (check out vsp.com/ofers) $195
Frequency Limitations Every 12 months
Lenses
Single Vision, Lined Bifocal, and Lined Trifocal Copay included in materials
Anti-glare Coating $0 copay
Tints/Light-reactive $0 copay
Standard Progressive Lenses $0 copay
Premium Progressive Lenses $95-$105
Custom Progressive Lenses $150-$1750
Frequency Limitations Every 12 months
Contacts (instead of glasses)
Contacts Allowance $175
Contact Lens Exam (itting and evaluation) Up to $60
Frequency Limitations Every 12 months
Out-of-Network Beneits
Exam Up to $45
Frame Up to $70
Single Vision Lenses Up to $30
Lined Bifocal Lenses Up to $50
Lined Trifocal Lenses Up to $65
Progressive Lenses Up to $50
Contacts Up to $105
This is a high-level summary of your beneit coverage. Full coverage details are available in your summary plan description (SPD). In the event there
is a discrepancy between what is relected in this guide and what is communicated in your SPD, the terms of your SPD will prevail.
Associate Bi-Weekly Vision
Contributions Finding In-Network Providers
Vision Plan—Bi-Weekly Remember to visit in-network dentists to receive the
Associate Only $3 .95 deepest level of discount on your services.
Associate and Spouse $5 .72
Associate and Child(ren) $6 .80 To ind a participating in-network provider in your area, go
Family $10 .87 to www.vsp.com or call 800.877.7195 .
14
We partner with VSP to offer you and your family members vision insurance. Visit www.vsp.com to ind in-
network providers and access to a variety of online tools and programs.
VSP
In-Network
Copays
Exam $10
Materials $25
Frames
Frames Allowance $175
Featured Frames Allowance (check out vsp.com/ofers) $195
Frequency Limitations Every 12 months
Lenses
Single Vision, Lined Bifocal, and Lined Trifocal Copay included in materials
Anti-glare Coating $0 copay
Tints/Light-reactive $0 copay
Standard Progressive Lenses $0 copay
Premium Progressive Lenses $95-$105
Custom Progressive Lenses $150-$1750
Frequency Limitations Every 12 months
Contacts (instead of glasses)
Contacts Allowance $175
Contact Lens Exam (itting and evaluation) Up to $60
Frequency Limitations Every 12 months
Out-of-Network Beneits
Exam Up to $45
Frame Up to $70
Single Vision Lenses Up to $30
Lined Bifocal Lenses Up to $50
Lined Trifocal Lenses Up to $65
Progressive Lenses Up to $50
Contacts Up to $105
This is a high-level summary of your beneit coverage. Full coverage details are available in your summary plan description (SPD). In the event there
is a discrepancy between what is relected in this guide and what is communicated in your SPD, the terms of your SPD will prevail.
Associate Bi-Weekly Vision
Contributions Finding In-Network Providers
Vision Plan—Bi-Weekly Remember to visit in-network dentists to receive the
Associate Only $3 .95 deepest level of discount on your services.
Associate and Spouse $5 .72
Associate and Child(ren) $6 .80 To ind a participating in-network provider in your area, go
Family $10 .87 to www.vsp.com or call 800.877.7195 .
14
