Page 13 - Kirstie Test BenSum

Voluntary Vision
Nancy Bisson
Joy Hebert
Northern will continue to offer the DeltaVision Voluntary Vision Plan (EyeMed Network) benefit to those employees working 20+ hours per week. Employees are eligible for voluntary vision insurance on the first of the month following 60 days of employment.
Please note If you are on the Northeast Delta Dental plan, you are offered a retail discount through EyeMed which is simply a small discount off of retail prices. Much of the time the stores run promotions that are a better than the discount.
The discount is not of value to those with the fully insured DeltaVision plan because the DeltaVision plan allows a 40% discount off any prescription glasses purchased outside of the network. That is a better value than what you can get on the Dental EyeMed discount.
You cannot use the DeltaVision plan and the Dental Eyemed discount together.
A rate table with a breakdown of your pre-tax contribution for the 2020 – 2021 plan year, and a plan overview are outlined below.
DeltaVision Plan Summary
Weekly Rates
Employee
Employee + One
Family
Deductions
$1.33
$2.29
$4.09
Bi-Weekly Rates
Deductions
$2.66
$4.57
$8.17
Network Benefit
Non-Network Reimbursement
Exam every 12 months
Member pays $20; plan pays balance
$35
Standard Contact Lens Fit/Follow-up
Member pays up to $55
None
Premium Contact Lens Fit/Follow-up
10% discount off retail
None
Frames every 24 months: (any available frame at provider location)
$130 allowance, then 20% off balance
$65
Standard Plastic Lenses every 12 months
Single/Bifocal/Trifocal
Member pays $20; plan pays balance
$25/$40/$55
Lens Options
UV coating/Tint/Standard scratch resistance
Member pays $15 each
None
Standard polycarbonate
Member pays $40
None
Standard anti-reflective coating
Member pays $45
None
Standard progressive
Member pays $85
None
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