Page 13 - Draken Intl. 2022 OE Flipbook

Vision Plan

The vision plan provides coverage for routine eye exams and pays for all or a portion of the cost of glasses or contact
lenses. You can choose any provider; however, you always save money if you see in-network providers. We offer a vision
plan through Guardian.

Guardian Vision
Plan Provisions In-Network (VSP Choice) Out-of-Network (Reimbursement)
Exam $10 copay Up to $39
copay combined with eye exam
Frames Up to $46
80% of amount over $130 allowance
Lenses
• Single vision lenses $25 copay Up to $23
• Bifocal lenses $25 copay Up to $37
• Trifocal lenses $25 copay Up to $49
Lenticular $25 copay Up to $64

Polycarbonate lenses for dependent children Covered at 100% up to age 19, otherwise $33
Contact Lenses
• Elective (in lieu of glasses) $130 allowance for contacts Up to $100

Frequency
• Exam 12 Months 12 Months
• Lenses 12 Months 12 Months
• Frames 24 Months 24 Months
• Contact lenses 12 Months 12 Months

Vision Discounts and Additional Savings (In-Network Only)
• Laser Vision Correction: Up to 15% off the usual and customary rate (UCR*) or 5% off promotional price
• Additional pair of frames and lenses: 20% off retail price (must be within 12 months of the eye exam)
• Contact Lenses (evaluation and fitting): 15% off the usual and customary rate (UCR*)
*UCR is the cost of a service in a geographic area based on what providers in the area usually charge for the same or similar services.

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