Page 13 - Goodwill of SWPA 2022 Benefits 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 offer a vision
plan through Davis Vision.

Gold Basic
Plan Provisions In-Network In-Network

Exam $10 copay No copay
Frames Up to $100 Up to $60
Standard Corrective
Lenses*
● Single vision lenses Covered at 100% Covered at 100%
● Bifocal lenses Covered at 100% Covered at 100%
● Trifocal lenses Covered at 100% Covered at 100%
● Lenticular Covered at 100% Covered at 100%
Contact Lenses
(in lieu of glasses) $120 allowance $75 allowance
Frequency
● Exam Once every 12 months Once every 12 month
● Lenses One pair every 12 months One pair every 12 months
● Frames One frame every 12 months One frame every 12 months
● Contact lenses One pair every 12 months One pair every 12 months
*Does not include special lens coatings

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