Page 11 - Sonsio 2021 Annual Benefits Enrollment
P. 11
2021
Dealer Tire Benefits Enrollment
Vision
We partner with VSP to offer you and your family members vision insurance. Visit www.vsp.com to ind in-
network providers and access to a variety of online tools and programs.
In-Network Associate Bi-Weekly Vision
Copay Contributions
Exam $10
Materials $25 Vision Plan-biweekly
Frames Associate Only $3 .95
Frames Allowance $175 Associate and Spouse $5 .72
Featured Frames Allowance $195 Associate and Child(ren) $6 .80
(check out vsp.com/ofers) Family $10 .87
Frequency Limitations Every 12 months
Lenses
Single Vision, Lined Bifocal, Copay included in materials Finding In-Network Providers
and Lined Trifocal
Anti-glare Coating $0 Copay Remember to visit in-network dentists to receive the
deepest level of discount on your services.
Tints/Light-reactive $0 Copay
Standard Progressive Lenses $0 Copay To ind a participating in-network provider in your area go
Premium Progressive Lenses $95 $105 to www.vsp.com or call 800.877.7195 .
Custom Progressive Lenses $150 $1750
Frequency Limitations Every 12 months
Contacts (instead of glasses)
Contacts Allowance $175
Contact Lens Exam Up to $60
(itting and evaluation)
Frequency Limitations Every 12 months
Additional Provisions
Exam Up to $45
Frame Up to $70
Single Vision Lenses Up to $30
Lined Bifocal Lenses Up to $50
Lined Trifocal Lenses Up to $65
Progressive Lenses Up to $50
Contacts Up to $105
This is a high level summary of your beneit coverage. Full coverage
details are available in your summary plan description (SPD). In the
event there is a discrepancy between what is relected in this guide and
what is communicated in your SPD, the terms of your SPD will prevail.
11
Dealer Tire Benefits Enrollment
Vision
We partner with VSP to offer you and your family members vision insurance. Visit www.vsp.com to ind in-
network providers and access to a variety of online tools and programs.
In-Network Associate Bi-Weekly Vision
Copay Contributions
Exam $10
Materials $25 Vision Plan-biweekly
Frames Associate Only $3 .95
Frames Allowance $175 Associate and Spouse $5 .72
Featured Frames Allowance $195 Associate and Child(ren) $6 .80
(check out vsp.com/ofers) Family $10 .87
Frequency Limitations Every 12 months
Lenses
Single Vision, Lined Bifocal, Copay included in materials Finding In-Network Providers
and Lined Trifocal
Anti-glare Coating $0 Copay Remember to visit in-network dentists to receive the
deepest level of discount on your services.
Tints/Light-reactive $0 Copay
Standard Progressive Lenses $0 Copay To ind a participating in-network provider in your area go
Premium Progressive Lenses $95 $105 to www.vsp.com or call 800.877.7195 .
Custom Progressive Lenses $150 $1750
Frequency Limitations Every 12 months
Contacts (instead of glasses)
Contacts Allowance $175
Contact Lens Exam Up to $60
(itting and evaluation)
Frequency Limitations Every 12 months
Additional Provisions
Exam Up to $45
Frame Up to $70
Single Vision Lenses Up to $30
Lined Bifocal Lenses Up to $50
Lined Trifocal Lenses Up to $65
Progressive Lenses Up to $50
Contacts Up to $105
This is a high level summary of your beneit coverage. Full coverage
details are available in your summary plan description (SPD). In the
event there is a discrepancy between what is relected in this guide and
what is communicated in your SPD, the terms of your SPD will prevail.
11
