Page 15 - 2021 ASG Benefit Guide
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Vision plan
The vision plan provides coverage for routine eye exams and pays for all or a portion of the cost of glasses or contact
lenses. You can choose any provider; however, you always save money if you see in-network providers. We offer a vision
plan through EyeMed.
EyeMed Vision Plan
Plan Provisions In-Network Out-of-Network
Exam $10 copay Up to $35
$120 allowance;
Frames Up to $48
$20 off the balance over $120
Lenses
΅ Single vision lenses $25 copay Up to $25
΅ Bifocal lenses $25 copay Up to $40
΅ Trifocal lenses $25 copay Up to $60
Contact Lenses
΅ Elective $135 allowance; Up to $95
15% off the balance over $135
΅ Medically necessary $135 allowance; Up to $95
15% off the balance over $135
Frequency
΅ Exam 12 Months 12 Months
΅ Lenses 12 Months 12 Months
΅ Frames 24 Months 24 Months
΅ Contact lenses 12 Months 12 Months
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