PowerPoint Presentation

VISION Delta VISION Plan # 130

IN NETWORK Eye Examination - Once every 12 months Frame Allowance - Once every 24 months Prescription Glasses - Once every 12 months Contact Lenses fitting and evaluation OUT OF NETWORK Eye Examination - Once every 12 months Frame Allowance - Once every 24 months Prescription Glasses – Once every 12 months Contact Lenses fitting and evaluation

$10 Copay

Covered up to $130

$25 Copay

Member pays up to $60

Member pays up to $45 Member pays up to $70

Member pays up to $30/$50/$65

Member pays up to $105

EMPLOYEE MONTHLY DEDUCTIONS Employee

$1.00 $2.02 $2.16 $3.44

Employee/Spouse Employee/Child(ren)

Family