Page 12 - 2016 Enrollment
P. 12
12
Vision
Voluntary Vision
The company will continue to offer voluntary vision coverage through
Vision Beneits of America (VBA). To ind an in-network vision
provider, visit www.visionbeneits.com. There is an individual two year
commitment if you elect vision coverage.
Monthly Voluntary Vision Contribution
Employee $4.05
Employee + one dependent $7.35
Employee + family $9.95
As a reminder, VBA no longer uses paper beneit forms for services
rendered through a VBA participating provider. Instead, the member
will need to visit VBA’s website to verify eligibility and search for a
provider in their area. When making the appointment, the member would
notify the VBA provider that VBA is the insurance carrier. All VBA
participating providers will be able to process claims electronically. If a
member chooses to use a non-participating provider, an out-of-network
reimbursement form is available on the website, www.visionbeneits.com.
Vision Beneits of America
In-Network Out-of-Network
Exam
$0 copay Up to $40 reimbursement
Lenses
Single $20 copay Up to $40 reimbursement
Bifocal $20 copay Up to $50 reimbursement
Trifocal $20 copay Up to $75 reimbursement
Lenticular $20 copay Up to $100 reimbursement
Frames
Covered with $20 copay if Up to $50 reimbursement
within the plan’s wholesale
allowance
Contacts* (in lieu of glasses)
Elective contact lenses Up to $150 Up to $150 reimbursement
Medically necessary UCR, as determined by Up to $300 reimbursement
(requires prior VBA
authorization from VBA)
Frequency
Exam, lenses, or contacts 12 months
Frames 24 months
* The contact allowance is applied to all services/materials associated with contact lenses. This
includes, but is not limited to, contact exam, itting, dispensing, cost of lenses, etc. There is
no guarantee the contact allowance will cover the entire cost.
Employee Benefits
Vision
Voluntary Vision
The company will continue to offer voluntary vision coverage through
Vision Beneits of America (VBA). To ind an in-network vision
provider, visit www.visionbeneits.com. There is an individual two year
commitment if you elect vision coverage.
Monthly Voluntary Vision Contribution
Employee $4.05
Employee + one dependent $7.35
Employee + family $9.95
As a reminder, VBA no longer uses paper beneit forms for services
rendered through a VBA participating provider. Instead, the member
will need to visit VBA’s website to verify eligibility and search for a
provider in their area. When making the appointment, the member would
notify the VBA provider that VBA is the insurance carrier. All VBA
participating providers will be able to process claims electronically. If a
member chooses to use a non-participating provider, an out-of-network
reimbursement form is available on the website, www.visionbeneits.com.
Vision Beneits of America
In-Network Out-of-Network
Exam
$0 copay Up to $40 reimbursement
Lenses
Single $20 copay Up to $40 reimbursement
Bifocal $20 copay Up to $50 reimbursement
Trifocal $20 copay Up to $75 reimbursement
Lenticular $20 copay Up to $100 reimbursement
Frames
Covered with $20 copay if Up to $50 reimbursement
within the plan’s wholesale
allowance
Contacts* (in lieu of glasses)
Elective contact lenses Up to $150 Up to $150 reimbursement
Medically necessary UCR, as determined by Up to $300 reimbursement
(requires prior VBA
authorization from VBA)
Frequency
Exam, lenses, or contacts 12 months
Frames 24 months
* The contact allowance is applied to all services/materials associated with contact lenses. This
includes, but is not limited to, contact exam, itting, dispensing, cost of lenses, etc. There is
no guarantee the contact allowance will cover the entire cost.
Employee Benefits
