Page 16 - iFLY Benefit Guide 01-20

Vision Plan

Guardian | Vision Plan
iFLY provides vision coverage through Guardian. You can see an Guardian in-network provider or an out-of-
network provider, however, your costs will be lower if you visit an in-network provider. If you visit an in-network
provider you will be responsible for a copayment at the time of your service. If you receive services from an out-of-
network doctor, you will pay all costs at the time of service and submit a claim for reimbursement.

Guardian
Plan Name PPO
Network Name VSP Choice Non-Network

Vision Benefits
Copay
- Examination $10 Copay N/A
- Materials N/A N/A
Examination (Every 12 Months) No Charge Up to $39 Reimbursement
Lenses (Every 12 Months)
- Single Vision No Charge Up to $23 Reimbursement
- Bifocal No Charge Up to $37 Reimbursement
- Trifocal No Charge Up to $49 Reimbursement
- Lenticular No Charge Up to $64 Reimbursement
Frames (Every 24 Months) $130 Benefit, then 20% Discount Up to $46 Reimbursement
Contact Lenses (Every 12 Months) (in lieu of frames and lenses)
- Cosmetic / Elective $130 Benefit Up to $100 Reimbursement
- Medically Necessary No Charge Up to $210 Reimbursement
Cosmetic Extras Average 20-25% Discount Not Covered

Additional pair of Glasses 20% Discount Not Covered
Laser Vision Correction Average 15% Discount off Usual Not Covered
Price, or 5% Discount off
Promotional Price

Finding a Vision Provider
Go to www.guardiananytime.com. Refer to the “VSP Choice”” network

Guardian’s Vision plan utilizes the VSP network, which has the largest
network of private-practice eye care doctors in the industry. VSP’s network
includes 55,000 access points nationwide. Most of the U.S. population lives
within four miles of a VSP provider.

16 Team Member Benefits