Vision

Co-payments:

• $20.00 Exam
• $20.00 Materials
• $25.00 Contact Lens Fitting Fee

Services covered in full (in-network):

• Eye exams
• Standard single vision
• Bifocal
• Trifocal
• Lenticular lenses
• Medically necessary standard contact lenses

Standard frames are covered up to $125.00 (in network). Limits apply to out of network services.

Superior Vision Plan Summary

Find an In-Network Provider

Employee Monthly Premiums:

Coverage Tier	Monthly Premium
Individual Coverage	$9.16
Employee + Spouse	$15.70
Employee + Child(ren)	$16.02
Family Coverage	$25.80

Visit: www.superiorvision.com