Vision Insurance Superior Vision
EMPLOYEE BENEFITS
ABOUT VISION Vision insurance provides coverage for routine eye examinations and can help with covering some of the costs for eyeglass frames, lenses or contact lenses.
For full plan details, please visit your benefit website: www.mybenefitshub.com/texarkanaisd
Lens Add-Ons Your Cost Anti-scratch coating $15 You can request your vision id card by contacting Superior Vision Ultraviolet coating $12 directly at 800-507-3800. You can also go to Tints – solids / gradient $15 / $18 www.superiorvision.com and register/login to access your account Polycarobonate lenses $40 by clicking on “Members” at the top of the page. You can also Blue light filtering $15 download the Superior Vision mobile app on your smart phone. Digital Single Vision $30 Progressive lenses Vision Rates (standard/premium/ultra/ $55 / $110 / $150 / $225 Employee Only $7.68 ultimate) Employee and Spouse $15.18 Anti-reflective coating Employee and Child(ren) $14.88 (standard/premium/ultra/ $50 / $70 / $85 /$120 ultimate) Employee and Family $22.62 Polarized lenses $75 Copays Frequency Plastic photochromatic lenses $80 Exam $10 Exam 12 months Hi-index (1.67 / 1.75) $80 / $120 Contact lens fitting Overage Discounts Amount copay (standard and $25 Frame 24 months Frames 20% off amount over allowance specialty) Convention contacts 20% off amount over allowance Specialty in-network Disposable contacts 10% off amount over allowance $50 Contact lens fitting 12 months allowance Non-Covered Services Amount Frames, in-network $125 Eyeglass lenses 12 months Discounts Materials $25 Contact lenses 12 months Exams, frames, prescription 30% off retail Contacts, in lieu of lenses $150 glasses Contacts, misc options 20% off retail Disposable contact lenses 10% off retail Out-of-Network Retinal imaging $39 cost Lenses (per pair) In-Network Charge Reimbursement Additional Out-of-Network Amount Single Vision Covered in-full Up to $32 Reimbursements Bifocal Covered in-full Up to $46 Eye exam (MD) Up to $42 Trifocal Covered in-full Up to $61 Eye exam (OD) Up to $37 Progressives See description* Up to $61 Frame Up to $70 Contact lens fitting *Covered to provider’s in-office standard retail lined trifocal amount; member Not covered (standard/specialty) pays difference between progressive and standard retail lined trifocal, plus applicable co-pay Contact lenses UP to $105
How to Print your Vision ID Card:
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