Page 10 - 2016 ACProducts Non-Union
P. 10
2016 Beneits Guide
Vision Vision Coverage
Your vision coverage is offered through EyeMed. Vision coverage is
Your 2016 monthly contributions for a voluntary beneit, meaning you are responsible for the full premium
vision coverage are shown below. cost of this coverage. Your cost for this coverage will be separate
from medical and dental. A highlight of the plan design is shown
EyeMed PPO Plan
Employee $8.09 below. Your current vision coverage will rollover to next year unless
Employee + 1 $15.36 you make changes during Open Enrollment.
Family $22.55 In-Network Out-of-Network
Copay
Exam $10 copay $30 allowance
Lenses
Single $10 copay $25 allowance
Bifocal $10 copay $40 allowance
Trifocal $10 copay $60 allowance
Lenticular $10 copay $60 allowance
Frames
$150 allowance $75 allowance
20% off balance
over allowance
Contacts
Medically Necessary Paid In Full $200 allowance
Conventional $150 allowance $120 allowance
15% off balance
Disposable $150 allowance $120 allowance
Frequency
Exam 12 months
Lenses 12 months
Contacts (in lieu of glasses) 12 months
Frames 12 months
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Vision Vision Coverage
Your vision coverage is offered through EyeMed. Vision coverage is
Your 2016 monthly contributions for a voluntary beneit, meaning you are responsible for the full premium
vision coverage are shown below. cost of this coverage. Your cost for this coverage will be separate
from medical and dental. A highlight of the plan design is shown
EyeMed PPO Plan
Employee $8.09 below. Your current vision coverage will rollover to next year unless
Employee + 1 $15.36 you make changes during Open Enrollment.
Family $22.55 In-Network Out-of-Network
Copay
Exam $10 copay $30 allowance
Lenses
Single $10 copay $25 allowance
Bifocal $10 copay $40 allowance
Trifocal $10 copay $60 allowance
Lenticular $10 copay $60 allowance
Frames
$150 allowance $75 allowance
20% off balance
over allowance
Contacts
Medically Necessary Paid In Full $200 allowance
Conventional $150 allowance $120 allowance
15% off balance
Disposable $150 allowance $120 allowance
Frequency
Exam 12 months
Lenses 12 months
Contacts (in lieu of glasses) 12 months
Frames 12 months
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