Page 11 - 2015 Reznor Union Enrollment Guide
P. 11
Nortek
Vision Care
Vision Care Vision beneits are essential to
Out-Of-Network maintaining your overall health and
In-Network “Member” Costs Reimbursement
Eye Exam $10 copay Up to $35 well-being . Our vision care coverage is
through EyeMed, and includes beneits
Contact Lens it and follow-up for in-network and out of network care .
Standard Up to $55 N/A
Premium 10% off retail N/A You can apply your vision beneits
toward any eye exam, any available
Frames frames, or brand of contact lenses that
$0 copay, $150 allowance; 20% Up to $45 it your lifestyle.
off balance over $150
Standard Plastic Lenses How to Find a Vision
Single vision $15 copay Up to $25 Provider
Bifocal $15 copay Up to $40 Visit www.eyemedvisioncare.com
Trifocal $15 copay Up to $55 and select the Insight Network.
Lenticular $15 copay Up to $55
Standard Progressive $80 copay Up to $40
Premium Progressive $100-125 copay Up to $40
(Tier 1-3)
Premium Progressive $80 copay 80% of charge less Up to $40
(Tier 4) $120 allowance
Contact Lenses (allowance covers materials only)
Conventional $0 copay, $150 allowance; 15% Up to $105
off balance over $150
Disposables $0 copay, $150 allowance, plus Up to $105
balance over $150
Medically necessary $0 copay; paid in full Up to $210
LASIK and PRK 15% off retail price or 5% off N/A
promotional pricing
Frequency Limits
Exam Once every twelve months
Frames Once every twenty four months
Lenses or Contact Once every twelve months
Lenses
Please refer to your Summary Plan Description (SPD) for complete details of plan beneits,
limitations, and exclusions. In the event of a conlict between the SPD and this description,
the terms of the SPD will prevail.
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Vision Care
Vision Care Vision beneits are essential to
Out-Of-Network maintaining your overall health and
In-Network “Member” Costs Reimbursement
Eye Exam $10 copay Up to $35 well-being . Our vision care coverage is
through EyeMed, and includes beneits
Contact Lens it and follow-up for in-network and out of network care .
Standard Up to $55 N/A
Premium 10% off retail N/A You can apply your vision beneits
toward any eye exam, any available
Frames frames, or brand of contact lenses that
$0 copay, $150 allowance; 20% Up to $45 it your lifestyle.
off balance over $150
Standard Plastic Lenses How to Find a Vision
Single vision $15 copay Up to $25 Provider
Bifocal $15 copay Up to $40 Visit www.eyemedvisioncare.com
Trifocal $15 copay Up to $55 and select the Insight Network.
Lenticular $15 copay Up to $55
Standard Progressive $80 copay Up to $40
Premium Progressive $100-125 copay Up to $40
(Tier 1-3)
Premium Progressive $80 copay 80% of charge less Up to $40
(Tier 4) $120 allowance
Contact Lenses (allowance covers materials only)
Conventional $0 copay, $150 allowance; 15% Up to $105
off balance over $150
Disposables $0 copay, $150 allowance, plus Up to $105
balance over $150
Medically necessary $0 copay; paid in full Up to $210
LASIK and PRK 15% off retail price or 5% off N/A
promotional pricing
Frequency Limits
Exam Once every twelve months
Frames Once every twenty four months
Lenses or Contact Once every twelve months
Lenses
Please refer to your Summary Plan Description (SPD) for complete details of plan beneits,
limitations, and exclusions. In the event of a conlict between the SPD and this description,
the terms of the SPD will prevail.
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