Page 16 - Adreima Enrollment Guide

Annual Enrollment

Vision

Adreima’s vision carrier is Superior Vision. There will be no changes
to the vision plan in 2016. The Superior Vision network includes
select retail chains in addition to traditional providers.

Provider Non-Participating
Provider Coverage
Exam $10 copay Up to $37
Single vision lenses $10 copay Up to $29
Bifocal lenses $10 copay Up to $43
Trifocal lenses $10 copay Up to $53
Contact Lenses
Elective $130 allowance Up to $100
Medically necessary $10 copay Up to $210
Frames
$130 allowance, 20% Up to $65
discount
Frequency of Beneits
Exam Once every 12 months
Lenses Once every 12 months
Frames Once every 12 months

To ind a participating provider or retail store:

1. Visit www.superiorvision.com
2. Click the blue arrow “Members and Future Members”

3. Click the link to “Locate a Provider”

4. Enter the ZIP code and distance, then click the search button

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