Page 13 - Immucor Benefit Guide

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 offera visionplanthroughGuardian.Note:Guardian uses the VSP network of vision providersfor Immucor's
vision plan (www.vsp.com).

VisionPlan n
Plan Provision In-Network Out-of-Network

Exam $10 copay Up to $50 after $10 copay
Frames $150 allowance after $25 copay – 20% off balance Up to $48

Lenses
 Single vision lenses $25copay Up to $48
 Bifocal lenses $25copay Up to $67
 Trifocallenses $25copay Up to$86
Contact Lenses
 Elective Reimbursed up to $150 Up to $130
 Medically necessary Paid in full, after $25copay Up to$210
Frequency
 Exam 12months 12months
 Lenses 12months 12months
 Frames 24months 24months
 Contactlenses 12months 12months

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