Page 14 - Megatel Homes LLC Benefit Guide Effective 8-1-2020_Revised 051221

Vision Option:

Superior Vision

Per Pay Period Bi-weekly Dependent Information
We offer our full-time employees and their
Employee Only $ 3.34
eligible dependents vision benefits. Children
can join or remain on a parent’s vision plan
Employee + Spouse $ 6.67
until age 26. When a child turns 26, they will
Employee + Child(ren) $ 7.89 lose vision coverage on the last day of their
birth month.
Employee + Family $ 12.07

Benefits Highlights Plan Coverage (In-Network)

Copays:
Exam (Ophthalmologist or Optometrist) $10 Copay
Materials $25 Copay
Contact Lens Fitting (Standard) $25 Copay
Frequency:
Exams Every 12 Months
Lens / Contact Lens Fitting Every 12 Months
Frames Every 12 Months
Frequency is based On Date of Service
Standard Lens:

Single Vision Covered in Full after Copay
Lined Bifocal Covered in Full after Copay
Lined Trifocal Covered in Full after Copay
Progressive Lens (Standard) Covered in Full after Copay Up to Lined Trifocal Amount
Factory Scratch and Ultraviolet Coat Covered in Full after Copay
Other Lens Options Copays or Discounts Apply
Frames:

Frames Allowance $130 Retail Allowance
Contact Lenses in lieu of eye glasses,
materials only:
Frequency Every 12 Months
Lens Allowance $130 Retail Allowance

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

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