2018 FT Overview

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2018 BENEFITS PLAN OVERVIEW | 6
MBA CSi provides vision benefits through Vision Service Plan (VSP). VSP offers a national network
consisting of optometrists, ophthalmologists and opticians.
To find a provider, go to nd utilize the “Find a Doctor” feature for a list of
network providers closest to you. When you select your network make sure you select “VSP signature”
See chart below for additional benefit details.
Vision Benefits
Benefit Copay Frequency
WellVision Exam $10 Every 12 months
Prescription Glasses $25 See frame and lenses
Frame
- $130 allowance for a wide selection of
frames
- $150 allowance for featured frame brands
- 20% savings on the amount over your
allowance
Included in Prescription
Glasses
Every 12 months
Lenses
- Single vision, lined bifocal, and lines
trifocal lenses
- Polycarbonate lenses for dependent
children
Included in Prescription
Glasses
Every 12 months
Lens Enhancements
- Standard progressive lenses
- Premium progressive lenses
- Custom progressive lenses
$55
$95 - $105
$150 - $175
Every 12 months
Contacts (instead of glasses)
- $130 allowance for contacts; copay does
not apply
- contact lens exam (fitting and evaluation)
up to $60 Every 12 months
Tier
Semi-Monthly
Deduction
Employee Only $4.18
Employee + 1 Dependent $6.38
Employee + 2 or More Depend-
ents
$11.43