Page 12 - Tritrax 2024 Benefit Guide
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Vision Option:
Humana
2024 Rate Information
Per Pay Period Bi-Weekly Dependent Information
Employee Only $3.19 TriTrax Rehabilitation offers employees the opportunity
to cover their spouses and dependent children.
Employee + Spouse $6.39 Children can join or remain on a parent’s vision plan
until age 26. When a child turns 26, they will lose vision
Employee + Child(ren) $6.06
coverage on the last day of their birth month.
Employee + Family $9.54
Frequency limitations are based on date of last service and not on calendar year.
Benefits—Vision 130 Plan In-Network Coverage
Copays:
Exam $10 Copay
Materials $15 Copay
Standard Contact Fitting Up to $40
Frequency:
Exams Every 12 Months
Lens Every 12 Months
Frames Every 24 months
Standard Plastic Lens:
Single Vision $15 Copay
Lined Bifocal $15 Copay
Lined Trifocal $15 Copay
Lenticular $15 Copay
Standard Progressive Add on to Bifocal Copay + $15
Scratch Resistant, UV Coating and Tints Covered in Full after $15 Copay
Frames:
Frames Allowance $130 Retail allowance + 20% off overage
Contact Lenses in lieu of eye glasses, materials only:
Frequency Every 12 Months
Lens Allowance $130 Retail allowance + 15% off overage
Please note: This summary is intended for general information purposes.
It is not a guarantee of benefits. Please reference the Benefit Summary or contact the carrier for specific details.
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