Colonial Benefits -- Vision Care

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Vision Care
What Is Covered

Please note the addition of a $10 vision exam copay and $15 frames/lenses copay for 2015-2016.

FREQUENCY OF SERVICEDEPENDENT AGE: 26
	Employee	Spouse	Children
Vision Exam	12 Months	12 Months	12 Months
Lenses	12 Months	12 Months	12 Months
Frames	12 Months	12 Months	12 Months

BENEFITS	VBA Participating Provider	Non-Participating Provider
	EMPLOYEE CAN SELECT EITHER:
	VBA Participating Doctor	Non-Participating Doctor
	Amount Covered	Amount Reimbursed
Vision Exam (for glasses)	100%	$35
Clear Standard Lenses (Pair):
Single Vision	100%	$40
Bifocal	100%	$50
Blended "No-Line" Bifocals	100%	$50
Trifocal	100%	$75
Lenticular	100%	$100
Progressive	100%	$75
1 yr Scratch Protection	100%	N/A
Solid or Gradient Lens Tints	100%	N/A
Photo-Sensitive	100%	N/A
Anti-Reflective	100%	N/A
UV 400	100%	N/A
Polycarbonate Lens Material	100%	N/A
Frame - OR - Contacts (selected in lieu of all eyeglass benefits listed above)***	100% *	$60
Elective	$190	$190
Medically Required	UCR**	$250

* Within the program's $75 wholesale allowance (approximately $185 to $225 retail).

** Usual, Customary and Reasonable as determined by VBA.

*** The contact allowance is applied to all services/materials associated with contact lenses.This includes, but not limited to, contact exam, fitting, dispensing, cost of lenses, etc. No guarantee the contact allowance will cover entire contact costs (materials/services).


Vision Care
	What Is Covered
	What Is Not Covered
	When Coverage Ends
	When Coverage Ends for a Dependent Child

Related Forms
	Vision Care Program
	LASIK Savings
	Qualsight LASIK
	Hearing Care Discount Program
	VBA Enrollment Form

Related Links
	Vision Benefits of America

Disclaimer: Colonial Benefits Online provides only an overview of your benefits from Colonial School District and The State of Delaware. Colonial School District and The State of Delaware reserve the right to amend or to terminate any benefit plan at any time, with or without notice. Review more important legal information about your benefits plans.