The Company offers eligible Team Members the Select Blend Vision Plan. This plan is administered by HealthComp, but does not have a network of providers. That means that you have the flexibility to access any provider you choose. Some providers, however, may not accept your insurance card. In this case, you must pay for the expense out-of-pocket and submit a claim form to HealthComp for reimbursement.
The following is a summary of the benefits provided under this plan:
| Vision Plan Summary |
COVERED SERVICES |
BENEFITS |
Exam - one per plan year |
Plan pays 100% of the cost of the exam after you pay a $20.00 co-pay. Maximum plan benefit under this provision is $60.00 per plan year |
Vision Supplies & Materials |
Plan pays 100% of usual and customary charges, up to a maximum of $250.00 per plan year. |
The Cost of the Vision Plan is as Follows:
| Tier Of Coverage |
Your Per Pay Period Contribution |
| Team Member (“TM”) Only |
$2.50 |
| TM + Child(ren) |
$4.00 |
| TM + Spouse/Domestic Partner |
$4.50 |
| Family |
$6.50 |
Vision Select Plan Documents:
Summary Plan Description
Vision Claim Form
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