Page 11 - 2020 HEICO Enrollment

2020
The Heico Companies, LLC Benefits Enrollment

VISION PLAN Did You Know?

VSP The frequencies listed for each
service are based upon the last
Heico offers a vision plan through Vision Service Plan (VSP) utilizing date of service received and do not
their Signature Plan Network. Please visit www.vsp.com for a complete reset at the beginning of the plan
year . Please contact VSP customer
listing of participating providers in-network. service at 800.877.7195 if you
have any questions regarding your
VSP Plan Design In-Network Out-of-Network last date of service .

Eye Exam (every 12 months) $25 copay $50 allowance after
$25 copay
Lenses (every 12 months)

„ Single Lens $50 copay $50 allowance after
$50 copay

„ Lined Bifocal Lens $50 copay $75 allowance after
$50 copay
„ Lined Trifocal Lens $50 copay $100 allowance after
$50 copay

„ Lenticular $50 copay $125 allowance after
$50 copay
$130 allowance
Frames (every 24 months) (plus 20% discount on $70 allowance
remaining balance)
Contact Lens — $130 allowance
Medical Necessary Contact $25 copay $210 allowance after
Lenses (12 Months) $25 copay

Elective Contact Lenses Exam Maximum of $60 $105 allowance for
professional fees
(12 Months) copay and materials
Diabetic Eye Care Program
„ Ophthalmological Service $20 copay
and Oice Visit (12 Months)
„ Gonioscopy (12 months) 100%
„ Extended Ophthalmoscopy 100% N/A
(6 months)
„ Fundus Photography (6 100%
months)
Average 15% of the regular price or 5% of the
Lasik Vision Correction promotional price . Discounts only available from
contracted facilities

2020 Employee Vision Contributions
Monthly
Employee $2
Employee + 1 $4
Family $6

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