Page 10 - 2019-2020 Country Financial Credit Union Benefit Booklet

Voluntary Vision Plan Summary

Country Financial Credit Union offers voluntary vision coverage through
Sun Life Financial. Vision care is personal and so is your relationship with
your eye doctor. With Sun Life Financial, you have access to the largest
national network of private-practice eye care doctors in the industry
through Vision Service Plan (VSP). VSP provides you with access to care
from great eye doctors, quality eyewear, and the affordable care you deserve. All members have

access to the VSP Choice Network, and ID cards are NOT necessary to receive services.
Dependent children can remain on the vision up to age 26.

Please refer to the Benefits Summary for limitations and exclusions.

VSP
Group: 934875
(800) 877-7195 / www.vsp.com

$10 Copay
WellVision Exam
Frequency: 1 per 12 months

$25 Copay
Frames: Lenses:
 $150 for the frame of your choice  Single lined, bifocal lined, trifocal,
Prescription Glasses
 20% off the amount over your lenticular, necessary contacts
allowance
 $80 allowance at Costco®
Frequency: 1 per 24 months Frequency: 1 per 12 months

Up to $60 Copay
Elective Contact Lenses  15% savings for your contact lens exam (fitting and evaluation)
(in place of lenses and frames)  $150 for contact lenses
Frequency: 1 per 12 months

Employee Bi-Weekly Pre-Tax Contributions
Employee Only $ 2.74
Employee + Spouse $ 5.09
Employee + Child(ren) $ 5.92
Employee + Family $ 9.17

Note: This is intended to be an easy-to-read summary (not a contract); the above items are only highlights of the plans. Additional limitations and exclusions
may apply to covered services. For a full description of your coverage, please refer to your Certificate of Coverage. In the event of any inconsistencies with
the comparison and the insurer’s Certificate of Coverage, the Certificate will control.

Salus Group © 2019 9