Page 10 - NextCare Holdings 2022 Benefits Guide
P. 10
VISION
NextCare ofers vision insurance through Delta Dental of Arizona
using the EyeMed network. You will receive an ID card in the mail after
enrollment.
In-Network Out-of-Network
Up to $30
Exam (every 12 months) $10 copay reimbursement
Single Lenses (every 12 $10 copay Up to $25
months) reimbursement
Bifocal Lenses (every 12 $10 copay Up to $40
months) reimbursement
Trifocal Lenses (every 12 $10 copay Up to $55
months) reimbursement
Lenticular Lenses (every 12 $10 copay Up to $55
months) reimbursement
Up to $75
Frames (every 12 months) $150 allowance, plus 20% of reimbursement
amount over allowance
Conventional: $150 allowance,
plus 15% of balance over $150
Elective Contacts (every 12 Up to $120
months in lieu of glasses) Disposable: $0 copay; $150 reimbursement
allowance, plus balance over
$150
Employee Vision Cost Per Pay Period
Employee Only $3.76
Employee and Spouse $6.01
Employee and Child(ren) $6.14
Family $9.90
10
NextCare ofers vision insurance through Delta Dental of Arizona
using the EyeMed network. You will receive an ID card in the mail after
enrollment.
In-Network Out-of-Network
Up to $30
Exam (every 12 months) $10 copay reimbursement
Single Lenses (every 12 $10 copay Up to $25
months) reimbursement
Bifocal Lenses (every 12 $10 copay Up to $40
months) reimbursement
Trifocal Lenses (every 12 $10 copay Up to $55
months) reimbursement
Lenticular Lenses (every 12 $10 copay Up to $55
months) reimbursement
Up to $75
Frames (every 12 months) $150 allowance, plus 20% of reimbursement
amount over allowance
Conventional: $150 allowance,
plus 15% of balance over $150
Elective Contacts (every 12 Up to $120
months in lieu of glasses) Disposable: $0 copay; $150 reimbursement
allowance, plus balance over
$150
Employee Vision Cost Per Pay Period
Employee Only $3.76
Employee and Spouse $6.01
Employee and Child(ren) $6.14
Family $9.90
10
