Page 15 - Sea Dwelling EE Guide 01-20

Guardian | Vision Plan
Sea Dwelling Creatures 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 $25 Copay N/A
Examination (Every 12 Months) No Charge after Copay Up to $39 Reimbursement
Lenses (Every 12 Months)
- Single Vision No Charge after Copay Up to $23 Reimbursement
- Bifocal No Charge after Copay Up to $37 Reimbursement
- Trifocal No Charge after Copay Up to $49 Reimbursement
Frames (Every 24 Months) $130 Benefit, then 20% Discount Up to $46 Reimbursement
$70 Costco Benefit
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

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

Guardian’s Vision plan utilizes the VSP network, which has the most
extensive list of private-practice eye care doctors in the industry. VSP also
contracts with Costco Optical, Visionworks, Clarkson Eyecare, VisionCare
Associates, Rxoptical, and other retail providers.

Additional Discounts Available
Laser Correction Surgery: Up to 15% off the usual charge or 5% off the promotional price when
you visit a network provider.

Continued Eyewear Savings: After your initial benefits have been utilized, you may receive an
additional pair of frames and lenses at a 20% discount to the retail price. Please note, this savings
is only available to you within 12 months of your eye exam.