Page 11 - 2018 CareHere Enrollment OOS
P. 11
CareHere
Vision
Vision Benefits
We partner with BlueCross BlueShield of Tennessee to offer you and your
family members vision insurance. Visit www.bcbst.com to ind in-network
providers and access to a variety of online tools and programs.
Vision Beneits At-a-Glance
In-Network*
Exams Covered in full, after $10 copayment
(every 12 months)
Lenses (every 12 months)
Single Covered 100% after $25 copay
Bifocal Covered 100% after $25 copay
Trifocal Covered 100% after $25 copay
Approved Frames (every 24 months)
$120 allowance
20% off balance over allowance
Approved Contact Lenses (every 12 months) in lieu of glasses
Elective—Conventional Lenses $120 allowance Vision coverage
15% off balance over allowance
Elective—Disposable Lenses $120 allowance is provided by
Medically Necessary 100% covered BlueCross BlueShield
of Tennessee.
* For out-of-network coverage details, please refer to your plan summary or an oficial plan
document.
Vision
Bi-Weekly
Employee Only $2.76
Employee + Spouse $5.52
Employee + Child(ren) $5.80
Family $9.11
11
Vision
Vision Benefits
We partner with BlueCross BlueShield of Tennessee to offer you and your
family members vision insurance. Visit www.bcbst.com to ind in-network
providers and access to a variety of online tools and programs.
Vision Beneits At-a-Glance
In-Network*
Exams Covered in full, after $10 copayment
(every 12 months)
Lenses (every 12 months)
Single Covered 100% after $25 copay
Bifocal Covered 100% after $25 copay
Trifocal Covered 100% after $25 copay
Approved Frames (every 24 months)
$120 allowance
20% off balance over allowance
Approved Contact Lenses (every 12 months) in lieu of glasses
Elective—Conventional Lenses $120 allowance Vision coverage
15% off balance over allowance
Elective—Disposable Lenses $120 allowance is provided by
Medically Necessary 100% covered BlueCross BlueShield
of Tennessee.
* For out-of-network coverage details, please refer to your plan summary or an oficial plan
document.
Vision
Bi-Weekly
Employee Only $2.76
Employee + Spouse $5.52
Employee + Child(ren) $5.80
Family $9.11
11
