Vision

VISION COVERAGE

The Superior Vision Services plan pays benefits for annual exams and corrective lenses. You pay a copay for exams, and the plan pays for frames and lenses up to certain limits. You may use in-network or out-of-network vision care providers, but you receive greater benefits when you use in-network providers. The plan will pay the allowance for either contact lenses or eyeglass frames once every 12 consecutive months. You can receive benefits for either eyeglasses or contact lenses in the same 12-month period, not both. In addition to the benefits described in the table on this page, you can take advantage of discounts through the Superior Vision Services plan. Find out more by logging on to www.superiorvision.com.

Summary of Coverage

Feature In-Network Out-of-Network
Comprehensive Eye Exam Covered in full after $10 copay Plan pays up to $42 for ophthalmologist (M.D.) or $37 for optometrist (O.D.)
Standard Lenses Covered in full after $10 materials charge
  • Single vision — up to $32 allowance
  • Bifocal — up to $46 allowance
  • Trifocal — up to $61 allowance
  • Lenticular — up to $84 allowance
Contact Lenses (per pair, in lieu of eyeglasses)
  • Medically necessary— covered in full
  • Cosmetic elective— up to $140 allowance
  • Medically necessary — up to $210 allowance
  • Cosmetic elective — up to $100 allowance
Standard Frames

Up to $150 allowance

Up to $53 allowance
Refractive Surgery (Lasik, Radial Keratotomy, or Photo-refractive Keratotomy) 5-50% discount No benefit

Contact Lens Fitting

The vision plan includes coverage for contact lens fittings. To be eligible for this benefit, you must use a network provider from the Superior Vision provider directory who has the code “CLI” next to his or her name or indicates “CFL” (contact lens fitting) on the Internet. The plan covers standard lens fitting as well as fitting for specialty lenses (up to a $50 retail allowance after a $35 copay.) The fitting benefit is in addition to your contact lens allowance. You can get your contact lens fitting and then get either glasses or contact lenses.

Additional Resources