Page 13 - Vision Benefits Plan Document

TEXAS MUTUAL INSURANCE COMPANY VISION PLAN

Network Maximum
Service Frequency of Service Provider Non-Network
Copayment Benefit
■ Aspheric Design
(Single Vision) 20%

■ Aspheric Design
(Multi Focal) 20%

■ Blended Bifocal 20%

■ Occupational
Double Segs 20%

■ Standard
Progressive $70

■ Deluxe
Progressive $110

■ Premium
Progressive $150

■ Platinum
Progressive $250

Coatings
■ Tint $14

■ UV Coating $16

■ Standard Anti-
Reflective $40

■ Premium Anti-
Reflective $80

■ Platinum Anti-
Reflective $90

■ Photochromic $67

■ Edge Coat 20%

■ Standard Scratch
Guard No charge

9 SECTION 4 - PLAN HIGHLIGHTS