Vision

Superior Vision

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

EMPLOYEE BENEFITS

How to Print your Vision ID Card:

You can request your vision id card by contacting Superior Vision directly at 800-507-3800. You can also go to www.superiorvision.com and register/login to access your account by clicking on “Members” at the top of the page. You can also download the Superior Vision mobile app on your smart phone.

Employee Only Employee and Spouse Employee and Child(ren) Employee and Family Vision Rates

$7.68 $15.18 $14.88 $22.62

Exam Copays

$10

Frequency Exam 12 months

Contact lens fitting copay (standard and specialty) $25 Frame 24 months

Specialty in-network $50 Contact lens fitting 12 months

allowance Frames, in-network $125 Eyeglass lenses 12 months Materials $25 Contact lenses 12 months Contacts, in lieu of $150glasses

Lenses (per pair) In-Network Charge Single Vision Bifocal Trifocal Progressives Covered in-full Covered in-full Covered in-full See description* Out-of-Network Reimbursement Up to $32 Up to $46 Up to $61 Up to $61

*Covered to provider’s in-office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co-pay Lens Add-Ons Anti-scratch coating Ultraviolet coating Tints – solids / gradient Polycarobonate lenses Blue light filtering Digital Single Vision Progressive lenses (standard/premium/ultra/ ultimate) Anti-reflective coating (standard/premium/ultra/ ultimate) Polarized lenses Plastic photochromatic lenses Hi-index (1.67 / 1.75) Overage Discounts Frames Convention contacts Disposable contacts Non-Covered Services Discounts Exams, frames, prescription lenses Contacts, misc options

Disposable contact lenses Retinal imaging Additional Out-of-Network Reimbursements Eye exam (MD) Eye exam (OD) Frame Contact lens fitting (standard/specialty) Contact lenses Your Cost $15 $12 $15 / $18 $40 $15 $30

$55 / $110 / $150 / $225

$50 / $70 / $85 /$120

$75 $80 $80 / $120 Amount 20% off amount over allowance 20% off amount over allowance 10% off amount over allowance Amount

30% off retail 20% off retail

10% off retail $39 cost Amount Up to $42 Up to $37 Up to $70 Not covered UP to $105