Vision Coverage

Keep your vision at its best by enrolling in the NAFEC Group Vision Plan from Superior Vision Services.
Outline of Benefits

In-network co-pays are paid directly to the provider. Out-of-network co-pays will be deducted from the out-of-network reimbursement. Materials co-pay applies to lenses and/or frames, not contact lenses.

	In-Network	Out-of-Network
Comprehensive Eye Exam - Ophthalmologist (MD)	Covered in Full	Up to $42
Comprehensive Eye Exam - Optometrist (OD)	Covered in Full	Up to $37
Standard Lenses (Per Pair):
Single Vision	Covered in Full	Up to $32
Bifocal	Covered in Full	Up to $46
Trifocal	Covered in Full	Up to $61
Lenticular	Covered in Full	Up to $84
Contact Lenses (Per Pair)
*Medical Necessary	Covered in Full	Up to $210
Elective**	Up to $120	Up to $100
Contact Lens Fitting Exam***
Standard	Covered in Full	Not Covered
Specialty	Up to $50	Not Covered
Frames-Standard**	Up to $125	Up to $68

* Contact lenses are in lieu of eyeglass lenses and frames benefit.
**The insured is responsible for paying any charges in excess of this allowance.
***Standard contact lens fitting applies to an existing contact lens user who wears disposable, daily wear, or extended wear lenses only. The specialty contact lens fitting applies to new contact lens wearers and/or a member who wears toric, gas permeable, or multi-focal lenses. For the specialty fit, the member is responsible for any charges over $50.

Plan Frequency		Monthly Rates
Comprehensive Exam	12 Months	Employee Only	$8.50
Contact Lens Fitting Exam	12 Months	Employee and Spouse	$16.90
Lenses	12 Months	Employee and Child(ren)	$16.50
Frames	24 Months	Employee and Family	$25.10
Contact Lenses	12 Months

Materials Discount SVP8-20

These discounts apply to upgrades on the covered frame and lenses only. For discounts on additional pairs, please refer to the Discounts on Additional Purchases.

Frames

20% off the difference between the covered frame allowance and the retail price of the selected frame. Note: Discounts do not apply when prohibited by the manufacturer.

 

Lens Options and Upgrades (covered pair of lenses)	Member pays 20% off retail up to:
Factory scratch coat	$13(single vision & standard lined multifocal lenses)
Ultra violet coat	$15(single vision & standard lined multifocal lenses)
Standard anti-reflective coat	$50(single vision & standard lined multifocal lenses)
High Index 1.6	$55(Single Vision Lenses Only)
Polycarbonate	$40(Single Vision Lenses Only)
Standard photochromic	$80(Single Vision Lenses Only)
Glass coloring	$35(Any Type Lenses)
Plastic, tints, solid, or gradients	$25(Any Type Lenses)
	Member Pays:
Power over 4.00 Sphere, 2.00D Cylinder & 5.00D Prism	20% discount off retail
Cosmetic finishing, beveling, edging & mounting	20% discount off retail
Miscellaneous options	20% discount off retail

Higher end or brand name lens upgrades are at an additional expense to you. These upgrades will be available at a 20% discount off retail.

View your benefits and provider listings at www.superiorvision.com.

Contact lenses can be purchased on-line and delivered directly to your door. Visit www.svcontacts.com for more information.

For assistance with using your plan, please contact Customer Service at (800) 507-3800.

Disclaimer: All final determinations of benefits, administrative duties, and definitions are governed by the Certificate of Insurance Coverage for your vision plan. Please check with your Benefits Administrator or Human Resources department if you have any questions.

Superior Vision Services, Inc
P.O. Box 967 Rancho Cordova, CA 95741
800-507-3800
www.superiorvision.com

The Superior Vision Plan is underwritten by National Guardian Life Insurance Company. National Guardian Life Insurance Company is not affiliated with The Guardian Life Insurance Company of America, a/k/a The Guardian or Guardian Life.