New Employee Benefits Enrollment - Dow Corning

VISION
Coverage is effective on your first day of work. See Benefit Enrollment Information page for details on
how to enroll for benefit coverage.
If you waive coverage or fail to enroll within two months from your start date, you will receive no
coverage for the current calendar year, and you must wait until the next annual enrollment period to
enroll for coverage.
Plan Highlights
The Dow Corning Vision Plan, administered by Spectera, offers coverage for lenses, frames and contact
lenses to both full-time and part-time employees. Everyone enrolled in a medical plan is automatically
enrolled in Spectera eye exam coverage, at no cost, and is considered a Spectera member.
Spectera offers two levels of benefits – Network and Out-of-Network – based on the provider you select.
In-Network Benefits
Spectera administers the following coverage when services are received from a network provider:
� Exam – A comprehensive vision exam from a network optometrist or ophthalmologist is
covered in full, once every 12 months, after the exam co-pay of $15. You do not need to be
enrolled in the Vision Plan to receive this coverage. Everyone enrolled in a medical plan is
automatically enrolled in Spectera eye exam coverage.
� Lenses – Plan lenses are covered once every 12 months, with no co-pay.
� Frames – One set of Plan frames is covered once every 12 months, with no co-pay. If you
choose a frame outside of Spectera’s selection, you will receive a $50 wholesale frame
allowance at a private practice provider, or a $130 retail frame allowance at a retail chain
provider.
� Contact lenses – You may select contact lenses in lieu of lenses and frames. If you use
disposable contact lenses, up to six boxes of Plan approved lenses will be covered every 12
months. If you choose non-Plan approved lenses, a $150 allowance will be applied every 12
months. The $150 allowance covers the fitting/evaluation fees, contact lenses and up to two
follow-up visits.
� To find a network provider, visit the Spectera website at www.spectera.com and click on the
Future Member feature. The Spectera website will indicate the providers’ level of participation;
use the Key to Services chart below.
Exam Only
Dispense Only
Exam and Dispense
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