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/lakeworthisd

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. Copays Services/frequency Monthly Premiums

Exam Materials1 $10 Exam $25 Frame 12 months Employee 24 months Employee + Spouse

Contact lens fitting $25 Lenses

12 months Employee + Child(ren) Contact lenses 12 months Family

Contact lens fitting 12 months In-network Out-of-network

Exam (Ophthalmologist) Exam (Optometrist) Frames Contact Lens Fitting (Standard2) Contact Lens Fitting (Specialty2) Lenses (standard) per pair Single Vision Bifocal Trifocal Progressive Lenticular Ultraviolet Coat

Covered In Full Covered In Full $150 retail allowance Covered In Full $50 retail allowance

Covered In Full Covered In Full Covered In Full Covered at lined trifocal level Covered In Full Covered In Full

Up to $42 Up to $37 Up to $60 Not Covered Not Covered

Up to $26 Up to $34 Up to $50 Up to $50 Up to $80 Not Covered

Factory Scratch Coat Covered In Full Not Covered

Polycarbonate for Dependent Children Covered In Full Contact Lenses2 $120 retail allowance

Not Covered Up to $100 retail

Medically Necessary Contact Lenses Covered in full Up to $210 retail

Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements All allowances are at a retail value; the insured is responsible for any charges in excess of this retail allowance. 1. Materials co-pay applies to lenses and frames only, not contact lenses. 2. Standard Contact Lens Fitting applies to a current contact lens user who wears disposable, daily wear, or extended wear lenses only. Specialty Contact Lens Fitting applies to new contact wearers and/or a member who wears toric, gas permeable, or multifocal lenses. 3. Contact lenses are in lieu of eyeglass lenses and frames benefit. $8.45 $13.51 $13.79 $22.24