Vision care chart should be inserted as next section following medical section:

What Is Your Vision Benefit?

The company provides your basic vision benefit with no weekly contribution required from you. Some services require a copay, and others are based on a discount schedule. You can also elect dependent vision care. The chart below shows your costs of services and coverages.

Vision Benefit*
(Employees Covered by a Bargaining Agreement)

*Note: Benefits limited to once every two years

Vision Services	Employee Copay	Cost for Dependent Coverage
Exam	$10	$35
Frames (up to $60)	$10(20% discount on amounts over $60)	$40(20% discount on amounts over $60)
Lenses: Single vision Bifocal Trifocal Lenticular 6.00 Diopters	$ 0 $ 0 $ 0 $ 0 $10	$43 $63 $79 $95 $10
Scratch Resistant Coating	$ 0	$ 0
Tints	$ s 8	$ 8
Other add-ons to basic lenses	20% discount	20% discount
Premium lenses No-line bifocals Featherwates Photograys Anti-reflective High index Transitions	20% discount 20% discount 20% discount 20% discount 20% discount 20% discount	20% discount 20% discount 20% discount 20% discount 20% discount 20% discount
Elective Contact Lenses: Exam Fit, lenses & follow-up (up to $75)	$10 $10 20% discount on amounts over $75	$35 $65 20% discount on amounts over $75
Disposable Contact Lenses Exam Fit, lenses & follow-up (up to $75)	$10 $10 No discount on amounts over $75	$35 $65 No discount on amounts over $75
Medically Necessary Contact Lenses: Exam Fit, lenses & follow-up (up to $200)	$10 $10 20% discount on amounts over $200	$35 **$85 20% discount on amounts over $200

*Cost may vary if the price of lenses is less than $200
*Two-year frequency limit for both employee and dependents