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:
Services/Frequency limits for both plans:
|Services||Superior Vision (Standard Plan)||Superior Vision Plus (Enhanced Plan)|
|Exam (MD)||Covered in full 1||Up to $42||Covered in full 1||Up to $42|
|Exam (OD)||Covered in full 1||Up to $37||Covered in full 1||Up to $37|
|Frames||$140 retail allowance||Up to $53||$150 retail allowance||Up to $53|
|Contact Lens Fitting (standard 2 )||Covered in full 1||Not covered||Covered in full1||Not covered|
|Contact Lens Fitting (standard 2 )||$50 retail allowance 1||Not covered||$50 retail allowance 1||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 (for dependent children only 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 description 3||Up to $61||$120 retail allowance5||Up to $61|
|Elective Contact Lenses 4||$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.