Page 12 - Success Academy | 21-22 Benefits Summary
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Vision Plans
The Vision Basic Plan allows for an annual check-up, and either a frame allowance of $170 every two years, or contact lenses annually.
The Vision Plus Plan also allows for the annual check-up, but increases the frame allowance to $250 and allows for new frames annually. If you don’t need prescription glasses, you can use your allowance toward ready-to-wear, non-prescription sunglasses from a VSP Provider. Visit VSP.com
Service
Frame Allowance
Frequency Contacts
Cost
Annual Visit
Vision Basic Plan
Once every 2 years
$105 Allowance / Uptoa$60Copay
$0 No copay
Vision Plus Plan
$250 Allowance $25 Copay
Annually
$105 Allowance / Uptoa$60Copay
$8 EE Only
$14 EE + Spouse $14 EE + Child(ren) $22 EE + Family
$0 No copay
$170 Allowance $25 Copay
$2 EE Only
$4 EE + Spouse $4 EE + Child(ren) $6 EE + Family
Both plans utilize the VSP Signature network.
Non-Network Reimbursement is up to $50 for a well vision exam, up to $70 for frames and up to $105 for contact lenses.
Telehealth
You can have live video appointments with board-certified doctors who are able to diagnose and prescribe, when appropriate. Costs vary between $15-$55. Visit MDLIVEforCigna.com
