Vision

Healthy eyes and clear vision are an important part of your overall health and quality of life. You may enroll yourself and your eligible dependents or you may waive vision coverage.

You do not have to be enrolled in medical coverage to elect vision coverage or cover the same dependents under medical and vision. You may elect vision care coverage, which provides affordable, quality vision care nationwide. Although vision care services and supplies are covered in-network and out-of-network, your benefits are generally greater when you use in-network providers. Your costs are based on the family members you choose to cover.

Plan Information

Plan Name: XXXX

Policy Number: #XXXX

Effective Date: XX/XX/XXXX

Provider Network: XXXX

In-Network Benefit Highlights

Deductible (Individual/Family)
$XX/$XX

Out-of-Pocket Max (Individual/Family)
$XX/$XX

Preventive Care
$XX

Primary Care Visit
$XX

Specialist Visit
$XX

Urgent Care
$XX

Emergency Room
$XX

Benefit Highlights

In-Network

Exams
$XX/$XX

Single Vision Lenses
$XX/$XX

Bifocal Lenses
$XX

Trifocal Lenses
$XX

Frames
$XX

Contacts (in lieu of glasses)
$XX

Provider Network

Exams
$XX/$XX

Single Vision Lenses
$XX/$XX

Bifocal Lenses
$XX

Trifocal Lenses
$XX

Frames
$XX

Contacts (in lieu of glasses)
$XX

Out-of-Network

Exams
$XX/$XX

Single Vision Lenses
$XX/$XX

Bifocal Lenses
$XX

Trifocal Lenses
$XX

Frames
$XX

Contacts (in lieu of glasses)
$XX

Plan Documents
Contact Information
Phone: XXX-XXX-XXXX
App: App Name
In-Network Benefit Highlights

Deductible (Individual/Family)
$XX/$XX

Out-of-Pocket Max (Individual/Family)
$XX/$XX

Preventive Care
$XX

Primary Care Visit
$XX

Specialist Visit
$XX

Urgent Care
$XX

Emergency Room
$XX

In-Network Highlights

Exams
$XX/$XX

Single Vision Lenses
$XX/$XX

Bifocal Lenses
$XX

Trifocal Lenses
$XX

Frames
$XX

Contacts (in lieu of glasses)
$XX

Provider Network Highlights

Exams
$XX/$XX

Single Vision Lenses
$XX/$XX

Bifocal Lenses
$XX

Trifocal Lenses
$XX

Frames
$XX

Contacts (in lieu of glasses)
$XX

Out-of-Network Highlights

Exams
$XX/$XX

Single Vision Lenses
$XX/$XX

Bifocal Lenses
$XX

Trifocal Lenses
$XX

Frames
$XX

Contacts (in lieu of glasses)
$XX

Plan Documents
Contact Information

Phone: XXX-XXX-XXXX
Website: www.website.com
App: App Name