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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. Visi

t 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

Vision Benefits

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