Vision Benefits

Vision insurance offers coverage for the routine care of your eyes and may provide coverage for eyeglasses and contact lenses. Your plan will pay for these services based upon the schedule below.

Keep in mind that your costs will generally be lower if you choose an in-network eye-doctor. To find an in-network eye-doctor, please visit www.surency.com/vision.

	In-Network	Out-of-Network	Frequency
Eye Exam	$10 Copay	$35	Once every 12 months
Lenses
Single Vision	$10 Copay	$25	Once every 12 months
Bifocal	$10 Copay	$40	Once every 12 months
Trifocal	$10 Copay	$55	Once every 12 months
Lenticular	$10 Copay	$55	Once every 12 months
Frames	$130 Allowance, 20% off balance	$65	Once every 24 months
Contact Lenses
Medically Necessary	$0 Copay	$200	Once every 12 months
Conventional	$130 allowance, additional 15% off balance	$100	Once every 12 months

	Per Pay Period Cost
Employee	$4.23
Employee + Spouse/Domestic Partner	$8.88
Employee + Child(ren)	$7.62
Family	$14.25

Downloads

Summary of Benefits

Group Number

40093

Provided By

Surency

Provider Website

https://www.surency.com/vision

Customer Service

866.818.8805

Resources

Frequently Asked Questions