Page 62 - 2022 Large Group benefits

Vision plans
With a a a a a a a a a a a a a a focus on on on on low member member out-of-pocket costs our vision plan plan options deliver value and choice No matter what plan plan you choose members can also take advantage of of of extra perks like free one-year eyeglasses breakage warranty discounted pricing on on on additional pairs of of glasses glasses and LASIK eye eye services The following vision plans
are available to to all 51–99 and 100+ customers Vision Care 100 Frequency
12 months
12 months
Option 1 $25
12 months
Option 2 $0
Option 3
Funding type
Copayments
Employer paid & voluntary
Employer paid & voluntary
Employer Paid
Eye examination Spectacle lenses
Eye examination1
Spectacle lenses
Frame
Contact lens evaluation fitting & follow-up care
Contact lenses
(in lieu of eyeglasses)
Eye examination Spectacle lenses
Eye examination1
Spectacle lenses
Frame
Contact lens evaluation fitting & follow-up care
Contact lenses
(in lieu of eyeglasses)
• • Fully covered or or or or or minimal copay for Davis Vision Exclusive Collection of of frames 2 2 or or or or or • • • $100 frame frame frame allowance allowance plus 20% off the overage at at in-network providers or or or or or • • $150 frame frame allowance allowance at Visionworks
$0
$10 $0
$0
24 months
12 months
12 months
12 months
24 months
12 months
24 months
24 months
24 months
12 months
12 months
24 months
Frame
allowance options Vision Care 130
Option 1 Option 2 Option 3
Funding type
Employer paid & voluntary
Employer paid & voluntary
Employer paid & voluntary
Copayments
$0
$0
Frequency
12 months
12 months
12 months
$10 $10 12 months
12 months
12 months
$10 $25
12 months
12 months
12 months
24 months
24 months
12 months
12 months
12 months
12 months
Frame
allowance options 61
1 Inclusive of of dilation when professionally indicated 2 Allowances are up to the amount shown for each plan type
• • Fully covered or or or or or minimal copay for Davis Vision Exclusive Collection of of frames 2 2 or or or or or • • • $130 frame frame frame allowance allowance plus 20% off the overage at at in-network providers or or or or or • • $180 frame frame allowance allowance at Visionworks