Page 14 - MB Aerospace Benefit Guide + Notices 2021

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 VSP.

Benefit In-Network Copay Out-of-Network Maximum Benefit

Exam (Once every 12 months) Covered at 100% after $10 copay Up to $45
Hardware $25 copay N/A
Frames (One pair every 24 months) Covered at 100% after copay up to the Up to $70
retail allowance of $150
Lenses (One pair every 12 months)
΅ Single Vision Lenses Covered at 100% after copay Up to $30
΅ Bifocal Lenses Covered at 100% after copay Up to $50
΅ Trifocal Lenses Covered at 100% after copay Up to $65

Contacts
΅ Elective $130 allowance , no copay $105 allowance
΅ Medical Necessary $25 copay $210 allowance

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