Vision

Superior Vision Benefits Guide

Fully insured Vision Care benefits will continue to be offered by Superior Vision Care.

Effective September 1, 2007, there will be a significant increase in provider access through the Superior Vision network of providers. Returning to the Network are the Luxottica group of stores. This includes Lenscrafters, Pearle Vision Centers, Sears Optical, Target Optical and J.C. Penney Optical. As of September 1st, there is approximately a 2% increase in the monthly premium.

Covered Services1	Network Benefits	Out-of-Network Benefits
Comprehensive eye exam by an ophthalmologist or optometrist	Covered in full after $35 Copay, but does not include the contact lens exam or fitting fees2	Up to $42 (ophthalmologist) Up to $37 (optometrist)
Standard lenses (per pair) - Plastic (CR39), clear, uncoated	Covered in full	Up to $32 (Single vision) Up to $46 (Bifocal) Up to $61 (Trifocal) Up to $84 (Lenticular)
Frames	Covered in full up to $140	Up to $53
Contact lenses	Covered in full (Non-elective)3 Up to $125 retail (Elective)3	Up to $210 (Non-elective) 3 Up to $100 (Elective)3

¹Only one comprehensive exam is covered per plan year. Only one pair of eyeglass lenses and one set of frames or one contact lens allowance is covered per plan year.
²Comprehensive eye exam subject to a $35 Copay (in-network only).
³Contact lenses in lieu of eyeglass lenses and one set of frames.

Contact Lenses

Contact lenses are a covered benefit to members who have one or more of these medical conditions:

• Aphakia
• Pseudo-aphakia
• Anisometropia
• Kerataconus
• When visual acuity cannot be corrected to 20/70 in the better eye except through the use of contact lenses

Contact lenses are also covered for those who prefer to wear contacts instead of glasses.

LASIK and other Eye Surgery

• Superior Vision offers a 20% discount off the Usual and Customary prices for LASIK surgery. This discount is provided through specially contracted ophthalmologists (Look for ‘RF’ in the Provider Directory).
• Blepharoplasty (eyelid surgery) is also available for the 20% discount.

Additional Features

• 20% discount on upgrades and add-ons to the eyeglass lens benefit from Network providers
• 10% discount on charges above the allowance for cosmetic (not medically necessary) contact lenses from Network providers
• 20% discount on additional purchases of eyeglasses
• 10% discount on additional purchases of contact lenses

NOTE: These discounts are not available at Wal-Mart Vision Centers.

Superior Vision
www.superiorvision.com
(800) 507-3800
M-F 5:00 AM - 6:00 PM PST
Sat 8:00 AM - 1:00 PM PST