Page 15 - 2015 CBRY Enrollment Guide
P. 15
ASARCO
Enhanced Vision Benefits Vision
ASARCO offers enhanced vision coverage through Superior Vision.
Employees that elect vision coverage will have access to Superior
Vision’s network of optometrists and ophthalmologists. This plan To Find a Superior Vision
allows you and covered family members to receive eye exams, lenses, Provider
frames, and contact lenses in many instances for the cost of a copay Go to www.superiorvision.com
when you visit an eye care professional in the Superior Vision network. Enter your city or zip code under
“Locate a Provider”, and click on
When visiting an out-of-network eye care professional, the plan Locate.
will pay up to an allowed amount and the member is responsible
for the remaining charges. You are responsible for iling a claim for
reimbursement when you visit an out-of-network provider.
2015 Vision Beneits
Beneits In-Network Out-of-Network
Exam (Ophthalmologist) $10 copay Up to $34
Exam (Optometrist) $10 copay Up to $26
Contact Lens Fitting $10 copay Not Covered
Frames $10 copay; Up to $130 Up to $65
Lenses (Standard) Per Pair $10 copay
Single Covered In Full Up to $29 Important change for
Bifocal Covered In Full Up to $43 2015!
Trifocal Covered In Full Up to $53 Employees can elect medical and
Lenticular Covered In Full Up to $84 vision separately. If you are currently
Contact Lenses Up to $130 Up to $100 enrolled in the medical plan you will
Medically Necessary Contact Lenses Covered In Full Up to $210
Beneit Frequency be automatically enrolled in the vision
Exam 12 Months plan. If you want to waive vision
Frames 24 Months coverage as of 1/1/2015, you will need
Contact Lenses (in lieu of eyeglasses) 12 Months to change your vision election in ADP
Lenses 12 Months ESS during annual enrollment.
2015 Vision Rates
Deduction Per Pay Period
Employee
Employee only $0.00
Employee and Spouse $0.42
Employee and Child/Children $0.32
Employee, Spouse, and Child/Children $1.34
Vision premiums are deducted on a pre-tax basis. Coverage elections can only be changed
during Annual Enrollment unless you experience a qualiied status change.
ASARCO salaried employees married to ASARCO hourly employees are only eligible to elect
beneits under the Salaried Beneit Plan.
15
Enhanced Vision Benefits Vision
ASARCO offers enhanced vision coverage through Superior Vision.
Employees that elect vision coverage will have access to Superior
Vision’s network of optometrists and ophthalmologists. This plan To Find a Superior Vision
allows you and covered family members to receive eye exams, lenses, Provider
frames, and contact lenses in many instances for the cost of a copay Go to www.superiorvision.com
when you visit an eye care professional in the Superior Vision network. Enter your city or zip code under
“Locate a Provider”, and click on
When visiting an out-of-network eye care professional, the plan Locate.
will pay up to an allowed amount and the member is responsible
for the remaining charges. You are responsible for iling a claim for
reimbursement when you visit an out-of-network provider.
2015 Vision Beneits
Beneits In-Network Out-of-Network
Exam (Ophthalmologist) $10 copay Up to $34
Exam (Optometrist) $10 copay Up to $26
Contact Lens Fitting $10 copay Not Covered
Frames $10 copay; Up to $130 Up to $65
Lenses (Standard) Per Pair $10 copay
Single Covered In Full Up to $29 Important change for
Bifocal Covered In Full Up to $43 2015!
Trifocal Covered In Full Up to $53 Employees can elect medical and
Lenticular Covered In Full Up to $84 vision separately. If you are currently
Contact Lenses Up to $130 Up to $100 enrolled in the medical plan you will
Medically Necessary Contact Lenses Covered In Full Up to $210
Beneit Frequency be automatically enrolled in the vision
Exam 12 Months plan. If you want to waive vision
Frames 24 Months coverage as of 1/1/2015, you will need
Contact Lenses (in lieu of eyeglasses) 12 Months to change your vision election in ADP
Lenses 12 Months ESS during annual enrollment.
2015 Vision Rates
Deduction Per Pay Period
Employee
Employee only $0.00
Employee and Spouse $0.42
Employee and Child/Children $0.32
Employee, Spouse, and Child/Children $1.34
Vision premiums are deducted on a pre-tax basis. Coverage elections can only be changed
during Annual Enrollment unless you experience a qualiied status change.
ASARCO salaried employees married to ASARCO hourly employees are only eligible to elect
beneits under the Salaried Beneit Plan.
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