Page 12 - Great Circle 2021 Benefits Guide
P. 12
Vision
We partner with Superior Vision to offer you and your family members vision insurance. Visit
www.superiorvision.com to ind in-network providers and access to a variety of online tools and programs.
In-Network
Exams Covered in full, after $10 Vision coverage provided by
(every 12 months) copayment Superior Vision.
Materials (applies to lenses
and frames only, not $25 copayment
contact lenses)
Lenses (every 12 months) Discount Features
Single Covered in full Look for providers in the provider directory who
Lined Bifocal Covered in full accept discounts, as some do not; please verify their
Lined Trifocal Covered in full services and discounts (range from 10%-30%) prior to
Polycarbonate Lenses For Covered in full for dependent service as they vary.
Dependent Children children to age 19
Frames (every rolling 24 months)
$130 allowance Additional Details
Approved Contact Lenses (every rolling 12 months) in Lieu of You have access to a wide range of retail providers
Glasses including Visionworks, Costco, LensCrafters, Walmart
$130 allowance Vision Centers, and Sam’s Club. Network provider status is
subject to change at any time. It is highly recommended
Contact Lens Fitting $30 copayment you double check the status of in-network providers before
Medically Necessary Covered in full your visit at www.superiorvision.com, and search for
providers in the Superior National network.
Vision Contributions Members can visit www.contactsdirect.com and
Per Pay Period receive full in-network beneits for new contacts.
Employee Only $3 .32 All new members receive personalized ID cards in the
Employee + 1 Dependent $5 .60 mail, beneit materials, and access to online information
Family $8 .35 after enrollment .
12
We partner with Superior Vision to offer you and your family members vision insurance. Visit
www.superiorvision.com to ind in-network providers and access to a variety of online tools and programs.
In-Network
Exams Covered in full, after $10 Vision coverage provided by
(every 12 months) copayment Superior Vision.
Materials (applies to lenses
and frames only, not $25 copayment
contact lenses)
Lenses (every 12 months) Discount Features
Single Covered in full Look for providers in the provider directory who
Lined Bifocal Covered in full accept discounts, as some do not; please verify their
Lined Trifocal Covered in full services and discounts (range from 10%-30%) prior to
Polycarbonate Lenses For Covered in full for dependent service as they vary.
Dependent Children children to age 19
Frames (every rolling 24 months)
$130 allowance Additional Details
Approved Contact Lenses (every rolling 12 months) in Lieu of You have access to a wide range of retail providers
Glasses including Visionworks, Costco, LensCrafters, Walmart
$130 allowance Vision Centers, and Sam’s Club. Network provider status is
subject to change at any time. It is highly recommended
Contact Lens Fitting $30 copayment you double check the status of in-network providers before
Medically Necessary Covered in full your visit at www.superiorvision.com, and search for
providers in the Superior National network.
Vision Contributions Members can visit www.contactsdirect.com and
Per Pay Period receive full in-network beneits for new contacts.
Employee Only $3 .32 All new members receive personalized ID cards in the
Employee + 1 Dependent $5 .60 mail, beneit materials, and access to online information
Family $8 .35 after enrollment .
12
