Page 17 - 2022 National Door Benefit Guide
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Vision Option:


          Superior Vision





                   Per Pay Period
                                                                    Dependent Information


                                                       National  Door  Industries,  Inc.  offers  our  employees
           Employee Only                 $3.16
                                                       the opportunity to cover their spouse or dependent
           Employee + Child(ren)         $5.69         children. Children can join or remain on a parent’s

           Employee + Spouse             $5.39         vision plan until age 26. When a child turns 26, they
           Employee + Family             $8.54         will lose vision coverage on the last day of their birth
                                                       month. This is an automatic process.




         Benefits                                                      (In-Network) Plan Coverage


         Copays:

           Exam                                                                     $10 Copay
           Materials                                                                $25 Copay

         Frequency: (Based on Date of Service)
           Exams                                                                  Every 12 Months
           Lenses                                                                 Every 12 Months
           Frames                                                                 Every 24 Months

           Contact Lenses                                                         Every 12 Months
         Standard Lenses:
           Single Vision                                                     Covered in Full after Copay

           Lined Bifocal                                                     Covered in Full after Copay
           Lined Trifocal                                                    Covered in Full after Copay
         Progressive Lenses                                             Paid Equal to Standard Trifocal lenses
         Scratch Resistant Coating                                           Covered in Full after Copay

         Ultraviolet Coating                                                 Covered in Full after Copay
         Frames:
           Frames Allowance                                                    $130 Retail Allowance

         Contact Lenses in lieu of eye glasses, materials only:
           Frequency                                                              Every 12 Months
           Lens Allowance (fitting, evaluation and follow-up)                  $130 Retail Allowance


         NOTE:  This is only a brief overview. Please see Benefit Summary for more details.
         Website:  www.superiorvision.com or Customer Service : 800-507-3800

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