Page 11 - Tessenderlo Kerley, Inc 2022 Benefit Guide
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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 Superior Vision/Versant.
Visit www.superiorvision.com to find a provider near you or call 800-507-3800.
Superior Vision/Versant Vision Plan Monthly Premiums
Plan Provisions In-Network Out-of-Network Coverage Level Superior Vision/Versant Vision Plan
Exam – Every 12 months $10 copay Up to $34 Employee Only $6.04
Materials $25 copay N/A
Employee + Spouse $12.08
Frames – Every 24 months $130 allowance Up to $63
Employee + Child(ren) $13.63
Lenses – Every 12 months
• Single vision Covered at 100% Up to $29 Employee + Family $21.09
• Bifocal Covered at 100% Up to $43
• Trifocal Covered at 100% Up to $53
Contact Lenses – Every 12 months
• Elective Up to $120 Up to $100
WELCOME BENEFIT BASICS MEDICAL DENTAL VISION FSA ADDITIONAL BENEFITS 401(k) CONTACTS LEGAL RIGHTS 11
