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