Groups offering Vision and/or Dental benefits to their employees can do so without requiring enrollment under a medical plan.
Members should use their medical ID card when getting a vision exam. MUST plans cover one (1) vision exam per benefit period under the medical plan at 100% of the allowable fee.
VISION
| MATERIALS | PER LENS | PER PAIR |
|---|---|---|
| Single vision lenses | $32 | $64 |
| Bifocal lenses | $41 | $82 |
| Trifocal lenses | $54 | $108 |
| Progressive lenses | $54 | $108 |
| Lenticular lenses | $77 | $154 |
| Necessary contacts | $165 | $330 |
| Elective contacts | N/A | $110* |
| Frames | N/A | $85 |
Members may choose one set of glasses (frames and lenses) or one set of contact lenses, but not both, during a given benefit period.
*One pair per year or one year supply of disposable lenses up to $110.
IMPORTANT NOTE: If a participant elects vision or dental coverage, but drops it at the end of the year, there is a two-year waiting period before the coverage can be reinstated. Participants may not drop vision or dental coverage mid-year unless they are also dropping medical coverage.
ELIGIBILTY REQUIREMENT: Employee enrollment is required to enroll any dependents in vision and/or dental benefits.
DENTAL
| DENTAL COVERAGE | |
|---|---|
| Maximum benefit/period/covered person (Combined type A, B, and C expenses) | $1,250 |
| Type A – Diagnostic/Preventive | |
| Deductible waived | No co-payment |
| Type B – Routine/Basic Care | |
| Deductible waived | 20% co-insurance |
| Type C – Major restorative | |
| $25 Deductible | 50% co-insurance |
| Orthodontia Coverage (for dependents under 19) | |
| Maximum lifetime benefit | $1,000 |
| Orthodontia | |
| $50 deductible | 50% co-insurance |