2018 BKSE Benefits Guide

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UNDERSTANDING
YOUR VISION PLAN
Vision Questions? Need to Locate a Provider?
Contact Principal
1-800-986-3343 or
10
General Information
Examination
Eyeglass Lenses
Single Vision
Bifocal
Trifocal
Lenticular
Frames
Contact Lens
Contribution Monthly Semi-Monthly Bi-Weekly
Employee $6.60 $3.30 $3.05
Employee + Spouse $17.34 $8.67 $8.00
Employee + Child(ren) $16.07 $8.04 $7.42
Employee + Family $26.81 $13.41 $12.37
$150 Allowance
$150 Allowance
Vision Coverage
$100 Allowance
$75 Allowance
$50 Allowance
Once every 12 months
$50 Allowance
Once every 12 months
The vision benefits are provided on a scheduled basis.
Covered charges equal the actual cost charged to the member, up to the allowance shown below.
Voluntary Vision - Principal
The vision plan covers a routine eye exam every 12 months and one of the following:
1. A set of frames each 24 months and two lenses (one pair) each 12 months, or
2. Two contact lenses (one pair). The maximum payment for a pair of contact lenses will be equal to the maximum payment
for single vision lenses plus frames.
For example: single vision lenses for $50 plus frames for $100 would equal an available contact lens benefit total of $150
for the 1st 12 months. The contact lens benefit available for the next 12 months, or in the 2nd year, would equal $50. This is
because the frame benefit of $100 is only payable once in any 24 consecutive month period.
Once every 12 months (in lieu of frames and lenses)
Once every 24 months
$100 Allowance
Employee Advocate
If you need additional assistance with your Medical, Dental, and/or Vision coverage, or questions regarding an Explanation of Benefits, a bill you
received or for any benefit or coverage issues and concerns, please call your Employee Advocate -
Traci Blake, at 888.517.3659 or email for personalized service.