Vision – FBCI – SBC Benefits

Vision Insurance

Eye exam for only $10 through network. No waiting periods. Pays up to $180 towards frames and up to $130 for contacts, plus other cost saving features.

Features

Benefit	Description	Copay	Frequency
Eye Exam	Focuses on your eyes, vision and wellness	$10	Every 12 months
Prescription Glasses	Options Below	-	-
Frame	Pay no more than $25 for Exclusive Collection Frames at participating locations or $130 Frame allowance at network locations or $180 Frame allowance at Visionworks¹ Plus 20% odd any amount over your allowance²	Included	Every 24 months
Lenses and enhancements³	Clear plastic single-vision, bifocal, trifocal, or lenticular lenses Polycarbonate lenses for dependent children Tinting of Plastic Lenses Scratch-Resistent Coating	$25	Every 12 months
Lens upgrades³	Polycarbonate lenses for adults High-Index Lenses 1.67 High-Index Lenses 1.74 Polarized Lenses Progressive Lenses (Standard / Premium / Ultra / Ultimate) Anti-Reflective (AR) Coating (Standard / Premium / Ultra / Ultimate) Ultraviolet Coating Plastic Photochromatic Lenses (Transitions® Signature^TM) Premium Scratch-Resistent Coating Scratch-Protection Plan (Single-Vision / Multifocal) Digital Single Vision Lenses Trivex Lenses Blue Light Filtering	$30 $55 $120 $75 $50/$90/$140/$175 $35/$48/$60/$85 $12 $65 $30 $20/$40 $30 $50 $15	Every 12 months
Prescription contacts⁴(instead of glasses)	15% off fitting, evaluation and follow-up $130 allowance for contacts Plus 15% off any amount over your allowance²		Every 12 months
Extra member savings (not insured benefits)
15% off standard laser vision correction or 5% off promotional prices at the LasikPlus® locations nationwide. No more than $39 on routine retinal imaging as an enhancement to an eye exam. 30% off additional pairs of eye glasses.² Free 1-yr. breakage warranty on your glasses - limitations apply.

Out-of-network coverage
Exam............................$40	Single vision lenses..........$40	Trifocal lenses...............$80	Elective contacts............$105
Frame...........................$50	Bifocal/Progressive lenses...$60	Lenticular lenses............$100	Visually required contacts...$225

Pricing

To check local providers, go to BrightBenefits.com and scroll down to the Eye Care Professionals and click on the BrightVision powered by Davis Vision, and then enter search information.

Family	Monthly Premium
Primary	$12.22/mo
Primary + Spouse	$18.76/mo
Primary + Children	$20.42/mo
Family	$27.22/mo

¹ Excludes Maui Jim® eyewear.
² Some limitations apply to additional discounts; discounts not applicable at all in-network providers.
³ Spectacle lens option may not be available for all locations.
⁴ Contact lens coverage varies by product selection. Visually Required contact are covered in full with prior approval. Davis Vision has done its best to accurately reflect plan coverage herein. If difference exist between this document and the plan contract, the contract will prevail. Product may vary by state.

Underwritten by National Guardian Life Insurance Company. National Guardian Life Insurance is not affiliated with Guardian Life Insurance Company of America, a/k/a The Guardian or Guardian Life.