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UNDERSTANDING
YOUR VISION PLAN
Exceptional Restaurants offers vision coverage through Blue Cross Blue Shield – Blue View Vision.
The vision plans allows you to use any vision provider you want, however, there is a network that can be
accessed for enhanced benefits. Visit
www.humanavisioncare.com to locate a participating vision provider.
Please contact your Human Resources Department for bi-weekly payroll deduction information.
Vision Plan
Exam
$10 copay in network
$42 allowance out of network
Lenses
Single - $10 copay in network / $40 allowance out of network
Bifocal - $10 copay in network / $60 allowance out of network
Trifocal - $10 copay in network / $80 allowance out of network
Frames
$130 Allowance, then 20% off remaining balance in network / $45
allowance out of network
Contact Lenses
Elective - $130 allowance, then 15% off any remaining balance in
network / $92 allowance out of network
Medically Necessary - 100% in network / $210 allowance out of
network
Frequency
Examinations once every 12 months
Lenses or contact lenses once every 12 months
Frames once every 24 months