Page 14 - United Capital EE Guide 04-17

VISION INSURANCE

ASSURANT/SUN LIFE | PPO VISION PLAN
The Assurant/Sun Life vision plan provides professional vision care and high quality lenses and frames through a broad network of
optical specialists. You will receive richer benefits if you utilize a network provider. If you utilize a non-network provider, you will be
responsible to pay all charges at the time of your appointment and will be required to file an itemized claim with Assurant.

Our Vision plan through Assurant/Sun Life utilizes the VSP network, which has the largest network of private-practice eye care
doctors in the industry. VSP’s network includes 50,000 access points nationwide. VSP also contracts with Costco Optical, Eye Care
Centers of America / Visionworks, and other affiliate retail providers. Please note, benefits may vary at affiliate locations.

ASSURANT / SUN LIFE
PPO
Network Name Network Non-Network
VISION BENEFITS
Copay
• Examination $10 Copay N/A
• Materials $10 Copay N/A
Examination (Every 12 Months) 100% Up to $52 Reimbursement
Lenses (Every 12 Months)
• Single Vision 100% Up to $55 Reimbursement
• Bifocal 100% Up to $75 Reimbursement
• Trifocal 100% Up to $95 Reimbursement
• Lenticular 100% Up to $125 Reimbursement
Frames (Every 12 Months) $130 Allowance, then 20% Discount Up to $57 Reimbursement
Contact Lenses (Every 12 Months) (in lieu of frames and lenses)
• Cosmetic / Elective $130 Allowance Up to $105 Reimbursement
• Medically Necessary $25 Copay Up to $210 Reimbursement
Laser Vision Correction Average 15% Discount off Regular Price Not Covered
or 5% Discount Off Promotional Price
Additional Glasses and Sunglasses 30% Discount from the same VSP N/A
Provider, or 20% Discount from any
VSP Provider within 12 Months of your
Last Exam

FINDING A DENTAL PROVIDER:
Go to www.vsp.com or call (800) 877-7195. Refer to the “VSP Signature” network when prompted.

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