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13

Odessa R-VII School District 2017

Vision Plan

The vision benefits will continue to be offered through Superior Vision. There are no plan or rate changes

effective July 1, 2017.

To identify participating providers, you may go to

www.superiorvision.com

or 1-(800)-507-3800.

Superior Vision

Copays

- Exams

- Materials

- Contact Lens Fitting Fee

$10

$25

$15

Frequency Limitations

- Exams

- Lenses

- Frames

- Contact Lens

Once every 12 months

Once every 12 months

Once every 24 months

Once every 12 months

Reimbursement Schedule

- Glass Lenses

- Single

- Bifocal

- Trifocal

- Contact Lenses

- Medically Necessary

- Elective

- Frames Standard

100%

100%

100%

100%

Up to $120

Up to $130

Vision Plan Cost

Employee Cost Per Month

Employee Only

$8.93

Employee + One

$15.17

Employee + Family

$25.19

This is only a summary. Please refer to your specific book/certificate for specific details. If a conflict arises, the booklet/certificate will govern in all cases.

Vision Insurance video for better consumerism:

Odessa School District Superior Vision Plan Why Superior Vision Member Portal Webinar What makes Us Superior Find an In- Network Provider