Page 9 - Michigan Fitness Foundation 2021 Booklet
P. 9
Michigan Fitness Foundation
January 2021 Vision Renewal
Current Renewal
Blue Cross Blue Shield Blue Cross Blue Shield
Blue VisionSM 12-12-12 Blue VisionSM 12-12-12
Plan Type PPO PPO
Plan Year 2020 2021
In-Network In-Network
Exam
Eye Exam - Copay $5 $5
Benefit Period 1 exam every calendar year 1 exam every calendar year
Lenses and Frames
Copay $10 $10
Allowance $130 $130
Benefit Period 1 every calendar year 1 every calendar year
Contact Lenses
Copay $10 $10
Allowance $130 $130
Benefit Period Covered up to allowance every calendar year Covered up to allowance every calendar year
Effective Date 1/1/2020 1/1/2021
Total Number of Employees 31 31
Monthly Total Vision Premium $315.87 $288.87
Annual Total Vision Premium $3,790.44 $3,466.44
Percentage Change From Current -8.55%
Annual Dollar Change From Current ($324.00)
