UT Benefits for Employees: Plan Year 2013-2014

Vision

Fully insured Vision Care benefits are offered by Superior Vision Services. You have two vision plan options to choose from:

  • Superior Vision (Standard Plan)
  • Superior Vision Plus (Enhanced Plan)

Both plans feature the following copayments:

  • Exam: $35
  • Materials: $0
  • Contact Lens Fitting: $35

Services/Frequency limits for both plans:

  • Exam: 1 per plan year
  • Frames: 1 per plan year
  • Contact Lens Fitting: 1 per plan year
  • Lenses: 1 per plan year
  • Contact Lenses: 1 per plan year
Services Superior Vision
(Standard Plan)
Superior Vision Plus
(Enhanced Plan)
  In-Network Out-of-Network In-Network Out-of-Network
Exam (MD) Covered in full1 Up to $42 Covered in full1 Up to $42
Exam (OD) Covered in full1 Up to $37 Covered in full1 Up to $37
Frames $140 retail allowance Up to $53 $150 retail allowance Up to $53
Contact Lens Fitting (standard2) Covered in full1
Not covered Covered in full1 Not covered
Contact Lens Fitting (standard2) $50 retail allowance1 Not covered $50 retail allowance1 Not covered
Lenses (standard) per pair:
Single Vision Covered in full Up to $32 Covered in full Up to $32
Bifocal Covered in full Up to $46 Covered in full Up to $46
Trifocal Covered in full Up to $61 Covered in full Up to $61
Polycarbonate (dependents up to age 25) Not Covered Not Covered Covered in full Not Covered
Scratch Coat (factory, single sided) Not Covered Not Covered Covered in full Not Covered
Ultraviolet Coat Not Covered Not Covered Covered in full Not Covered
Progressive Lens See description3 Up to $61 $120 retail allowance5 Up to $61
Elective Contact Lenses4 $125 retail allowance Up to $100 $150 retail allowance Up to $100

1 After co-pays. Co-pays apply to in-network benefits only.
2 See your benefits materials for definitions of standard and specialty contact lens fittings
3 Covered at the provider's in-office retail price for a standard lined trifocal; member pays difference between the progressive and the trifocal, plus applicable co-pay
4 Contact lenses are in lieu of eyeglass lenses and frames benefit
5 In-Network providers who do not accept our discount features will offer an equivalent value for progressive lenses. Any amount over $120 is the responsibility of the patient.

Additional discounts are available on LASIK, lens options and upgrades and mail-order contacts.

All costs and allowances are retail; you are responsible for any charges in excess of the retail allowances. All final determinations of benefits, administrative duties, and definitions are governed by the certificate of insurance for your specific benefits.

 

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