Page 6 - 2021 Open Sky Employee Benefits - SALARIED
P. 6
12/1/2020-11/30/2021 Employee Benefits Brochure
Salaried
Vision Plan – Anthem, provider and network change. Slight
change in benefits. Slight increase in some out of network benefits,
slight decrease in other our of network benefits. See last year’s
brochure for comparison or speak with Human Resources.
In- Network Out-of-Network
Exam Copay
(once every 12 months) $10 $42 allowance
Materials Copay
$25 See max reimbursements below
Lenses
(once every 12 months)
Single Covered after $25 copay
Bifocal Covered after $25 copay
$40 - $80 allowances
Trifocal Covered after $25 copay
Lenticular Covered after $25 copay
Frames $150 allowance + 20% off
remaining balance $45 allowance
(once every 24 months)
Contact Lenses
(once every 12 months)
Medically Necessary Covered 100% $210 allowance
Elective $150 allowance $105 allowance
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