Vision – XKIG

Vision Plan

This year we are proud to offer two vision plan options for employees through EyeMed.

The chart below is a brief summary of the in-network benefits. Please refer to the specific plan documents below for complete plan details.

	Base Plan	Buy-Up Plan
Member Responsibility	In-Network	In-Network
Routine Exams	$10	$10
Vision Materials
Frames	20% off balance over $130	20% off balance over $200
Contacts - Covered in lieu of frames
Conventional Contacts	15% off balance over $130	15% off balance over $200
Disposable Contacts	100% of balance over $130	100% of balance over $200
Medically Necessary Contacts	No charge	No charge
Standard Plastic Lenses
Single	$25	$10
Bifocal	$25	$10
Trifocal / Lenticular	$25	$10
Progressive	$80 - $200	$65 - $185

Frequency
Lenses - in lieu of contacts	Once every plan year	Once every plan year
Contacts - in lieu of lenses	Once every plan year	Once every plan year
Frames	Once every plan year	Once every plan year
Exams	Once every plan year	Once every plan year

	WEEKLY RATES	WEEKLY RATES
Employee	$1.66	$3.46
Employee + Spouse	$3.15	$6.57
Employee + Child(ren)	$3.32	$6.92
Employee + Family	$4.88	$10.17

Please refer to the summary plan description for complete plan details.