Page 11 - Tritrax 2023 Benefit Guide
P. 11
Vision Option:
Humana
2023 Rate Information
Per Pay Period Bi-Weekly
Employee Only $3.01 Dependent Information
TriTrax Rehabilitation offers employees the opportunity
Employee + Spouse $6.02 to cover their spouses and dependent children.
Children can join or remain on a parent’s vision plan
Employee + Child(ren) $5.72
until age 26. When a child turns 26, they will lose vision
Employee + Family $9.00 coverage on the last day of their birth month.
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.
11
