Page 9 - Benefit Guide
P. 9
VISION Remember to visit in-network
We partner with [Carrier] to offer you and your family members vision dentists to receive the deepest
level of discount on your services.
insurance. Visit www.[Carrier].com to ind in-network providers and
access to a variety of online tools and programs. To ind a participating in-
network dentist in your area
In-Network Out-of-Network go to [website.com] or call
Copay [555.555.5555].
Exam
Materials
Lenses
Single
Bifocal
Trifocal
Lenticular
Frames
Contacts
Frequency
Exam
Lenses
Contacts (in lieu of
glasses)
Frames
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.
Employee Vision Contributions
Employee Only $
Employee and Spouse $
Employee and Child(ren) $
Family $
[Client Name] 9 9
We partner with [Carrier] to offer you and your family members vision dentists to receive the deepest
level of discount on your services.
insurance. Visit www.[Carrier].com to ind in-network providers and
access to a variety of online tools and programs. To ind a participating in-
network dentist in your area
In-Network Out-of-Network go to [website.com] or call
Copay [555.555.5555].
Exam
Materials
Lenses
Single
Bifocal
Trifocal
Lenticular
Frames
Contacts
Frequency
Exam
Lenses
Contacts (in lieu of
glasses)
Frames
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.
Employee Vision Contributions
Employee Only $
Employee and Spouse $
Employee and Child(ren) $
Family $
[Client Name] 9 9
