Benefits Book 2018

201 8 Benefits Book

Claims Doctor offices should file claims with: Superior Vision Attn: Claims Processing PO Box 967 Rancho Cordova, CA 95741 Fax: 916-852-2277 You may also contact customer service at 1-800-507-3800 M onday - F riday 8 am to 9 pm EST Saturday 11 am - 4:30 pm EST Limitations Select Superior National Network to locate Network Providers. Please verify their services and discounts (range from 10%-30%) prior to service , as they vary.

Costs Participation in this program is voluntary; therefore the cost of this benefit will be paid by the employee. Discount s on Non-Covered Exam and Materials • Frames: 20% off amount over allowance • Lens options: 20% off retail • Progressives: • Refractive Surgery : 15% - 50% discount 20% off amount over standard progressive retail

The Two Vision Plans at a Glance

Coverage LevelOptions Basic Monthly

Enhanced Monthly

Pay Period

PayPeriod

Access to Participating Providers at https://www.superiorvision.com/

$ 3.56

$4.29

$ 2.15

Employee Only Employee/ Spouse Employee/ Child(ren) Employee/ Family

$7.12

$ 6.92

$13.83

$4. 18

$8.35

$ 8.25

$16.49

$8.75

$ 4.38

$ 6.35

$12.69

$ 10.50

$21 .00

Employee Engagement Committee Cookout: submitted by Cora Cunningham

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