Providence Engineering - 2023 Benefits Guide
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
VISION INSURANCE<br />
CARRIER: Sun Life<br />
● You will pay less out of pocket when you choose an in-network provider.<br />
● Locate an in-network provider at www.vsp.com .<br />
● You must submit a claim form for out-of-network expenses.<br />
● LASIK surgery discounts available.<br />
VISION<br />
ELECTION<br />
SEMI-MONTHLY<br />
PAYROLL DEDUCTION<br />
Employee Only $3.81<br />
Employee & Spouse $7.67<br />
Employee & Child(ren) $8.13<br />
Employee & Family $12.86<br />
COVERED BENEFITS<br />
IN-NETWORK<br />
Eye Exam (every 12 months)<br />
$10 copay<br />
Standard Plastic Lenses (every 12 months)<br />
Standard Progressive<br />
Premium Progressive<br />
Custom Progressive<br />
$25 copay<br />
$25 copay<br />
$95-$105 copay<br />
$150-$175 copay<br />
Frames (every 24 months)<br />
$130 allowance + 20% off balance<br />
$70 allowance at Costco®<br />
Contact Lenses in lieu of standard plastic lenses<br />
(every 12 months)<br />
Up to $60 / 15% savings on your contact lens exam<br />
(fitting and evaluation)<br />
$130 allowance<br />
17
Change language