Page 15 - Wesco Benefit Guide Effective 9-1-2021

Vision Option:

Humana

Effective 9-1-2021 Weekly Dependent Information

Employee Only $ 1.49 We offer our full-time employees and their eligible
dependents vision benefits. Children can join or
Employee + Spouse $ 2.99 remain on a parent’s vision plan until age 26. When
a child turns 26, they will lose vision coverage on
Employee + Child(ren) $ 2.84 the last day of their birth month.

Employee + Family $ 4.46

Benefits Highlights Plan Coverage (In-Network)

Copays:
Exam (Ophthalmologist or Optometrist) $10 Copay
Materials $15 Copay
Contact Lens Fitting (Standard) Up to $40
Frequency:
Exams Every 12 Months
Lens / Contact Lens Fitting Every 12 Months

Frames Every 24 Months
Frequency is based On Date of Service
Standard Lens:
Single Vision $15
Lined Bifocal $15
Lined Trifocal $15
Progressive Lens (Standard) $15
Factory Scratch and Ultraviolet Coat $15
Other Lens Options Copays or Discounts Apply

Frames:
$130 Retail Allowance
Frames Allowance
20% off balance over $130
Contact Lenses in lieu of eye glasses,
materials only:
Frequency Every 12 Months
$130 Retail Allowance
Lens Allowance
15% off balance over $130
NOTE: This is only a brief overview. Please see Benefit Summary and policy for more details.

Website: www.humana.com or Customer Service: 800-233-4013

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