VISION

Vision benefits are available for you and your family. This plan includes benefits for one routine eye exam, eyeglasses and/or contact lenses. Although you can go to any vision provider you choose, go to a Guardian VSP provider for the highest level of coverage. Please see the Guardian VSP benefit summary for additional discounts and savings. Check for network providers at www.GuardianAnytime.com.

The annual benefit is based on service frequency, which indicates when you will be eligible again for an exam or materials. Your premiums for this plan are deducted on a pre-tax basis.

Resources

Vision Benefit Summary

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	In-Network	Out-of-Network
Routine Eye Exam	$20 copay	N/A
Frequency	Every 12 months	Every 12 months
Eyeglass Frames	$20 copay, $150 allowance 20% discount over $130 Covered in full up to $46 wholesale or for a minimum of $130 retail	$70 maximum
Frequency	Every 24 months	Every 24 months
Eyeglass Lenses	$20 copay	Single vision – $50 maximum Bifocal – $75 maximum Trifocal – $100 maximum Lenticular $125 maximum
Frequency	Every 12 months	Every 12 months
Contact Lenses	$120 allowance, 15% discount on contact lens fit & follow-up*	$105 maximum
Frequency	Every 12 months	Every 12 months

*in lieu of eyeglass lenses