Bonner Springs/Edwardsville USD 204

Vi sion

Did you know that a routine eye exam can help to diagnose an array of medical conditions, including

diabetes? It is just as important to get your annual eye exam as it is to get your routine medical physical.

The following vision plan is available to you and your family members.

To identify participating providers, you may go to

or call 1-866-818-8805.

SURENCY

Copays

- Exams

- Lenses

- Single

- Bifocal

- Trifocal

$10

$25

Frequency Limitations

- Exams

- Lenses

- Frames

Once every 12 months

Once every 24 months

Reimbursement Schedule

- Exam

- Glass Lenses

- Single

- Bifocal

- Trifocal

- Contact Lenses

- Frames

100%

$115 allowance, 15% off amount of $115

$100 allowance

Your Vi sion Cost in 2016

EMPLOYEE MONTHLY DEDUCTIONS

EMPLOYEE

$7.45

EMPLOYEE + SPOUSE

$15.64

EMPLOYEE + CHILD(REN)

$13.40

FAMILY

$25.09