Page 18 - 2017 Benefits Enrollment Busey Pulaski
P. 18
2017 BENEFITS ENROLLMENT
Vision
Eye doctors detect problems in vision, overall eye health, and signs of
other health conditions like diabetic eye disease, high blood pressure, and
high cholesterol. We know your eyesight is precious to you, so we provide
vision beneits to make sure your trip to the eye doctor is reasonably
priced.
New this year, we have partnered with Aetna to offer you comprehensive
vision coverage. Keep in mind, the information in the chart provided is
a summary only. Please refer to your Certiicate of Coverage (COC) for
complete details of plan beneits, limitations, and exclusions on OTL.
Visit www.aetnavision.com.
In-Network Out-of-Network
Vision Exam
Up to $52
Exam copay $10 Copay reimbursement
Lenses
Up to $55
Single lens $25 Copay reimbursement
Up to $75
Bifocal lens $25 Copay reimbursement
Up to $95
Trifocal lens $25 Copay reimbursement
Frames
$130 allowance
Up to $57
Frame beneit then 20% discount reimbursement
on amount over
allowance
Contacts Lenses
$130 allowance
Up to $105
Conventional then 15% discount reimbursement
on amount over
Bi-weekly Rates allowance Up to $105
Associate only $3.15 Disposable $130 allowance reimbursement
Up to $210
Associate + spouse $5.96 Visually required $0 copay; paid-in-full reimbursement
Associate + child(ren) $6.11 Frequency
Family $8.26 Exam 12 months 12 months
Lenses 12 months 12 months
Contacts (in lieu of 12 months 12 months
glasses)
Frames 24 months 24 months
18 FIRST BUSEY CORPORATION
Vision
Eye doctors detect problems in vision, overall eye health, and signs of
other health conditions like diabetic eye disease, high blood pressure, and
high cholesterol. We know your eyesight is precious to you, so we provide
vision beneits to make sure your trip to the eye doctor is reasonably
priced.
New this year, we have partnered with Aetna to offer you comprehensive
vision coverage. Keep in mind, the information in the chart provided is
a summary only. Please refer to your Certiicate of Coverage (COC) for
complete details of plan beneits, limitations, and exclusions on OTL.
Visit www.aetnavision.com.
In-Network Out-of-Network
Vision Exam
Up to $52
Exam copay $10 Copay reimbursement
Lenses
Up to $55
Single lens $25 Copay reimbursement
Up to $75
Bifocal lens $25 Copay reimbursement
Up to $95
Trifocal lens $25 Copay reimbursement
Frames
$130 allowance
Up to $57
Frame beneit then 20% discount reimbursement
on amount over
allowance
Contacts Lenses
$130 allowance
Up to $105
Conventional then 15% discount reimbursement
on amount over
Bi-weekly Rates allowance Up to $105
Associate only $3.15 Disposable $130 allowance reimbursement
Up to $210
Associate + spouse $5.96 Visually required $0 copay; paid-in-full reimbursement
Associate + child(ren) $6.11 Frequency
Family $8.26 Exam 12 months 12 months
Lenses 12 months 12 months
Contacts (in lieu of 12 months 12 months
glasses)
Frames 24 months 24 months
18 FIRST BUSEY CORPORATION
