Page 10 - Skyworks Solutions, Inc.

Health

Vision Plans

Whether it’s a routine eye exam, glasses or
contact lenses, the vision plan has you covered.
This benefit includes coverage for glasses and
contact lenses. Skyworks offers two vision plans
administered by VSP.

Below is a summary of plan coverage based on
the type of service. For more information, refer to
Benefits Connection.

Vision Vision Plus Both Plans
In-network Copay/Coverage Out-of-network
Copay/Coverage

Eye Exams $10 copay. One exam covered per calendar year. Up to $52 allowance

Lenses $20 copay is applied to the lens and/or frame. Single vision up to $55
Plan provides lenses every calendar year. Lined bifocal up to $75
Lined trifocal up to $95

Frames $20 copay is applied to the lens $20 copay is applied to the lens Up to $50 allowance
and/or frame. You will receive a and/or frame. You will receive a
$150 allowance for a wide selection $150 allowance for a wide selection
of frames and $170 allowance for of frames and $170 allowance for
featured brands plus 20% off any featured brands plus 20% off any
amount over the allowance. amount over the allowance.
Plan provides for a frame every Plan provides for a frame every
other calendar year. calendar year.

Contact Lenses Up to $60 copay for the contact lens exam (fitting & evaluation) with Up to $105 allowance
a $105 allowance. Plan provides for contacts lenses every calendar year.

Additional benefits in the Vision Plus include each member’s choice from one of the following add ons:
1) progressive lenses, 2) photochromic lenses, 3) anti-reflective coating, 4) $250 frame allowance or 5)
$200 elective contact lens allowance.

Skyworks Solutions Employee Benefits Guide - U.S. 10