Vision Coverage
Liberty Health is proud to offer vision coverage to you and your eligible dependents. Benefits are provided through Superior Vision Care which is a part of MetLife.
In order to maximize your benefits, you will need to use a doctor that is in the Superior Vision network. However, you may use a doctor that is not in the network, but expect to pay more for non-discounted services. To locate a participating network provider, visit www.superiorvision.com or call 1-800-507-3800.
Upon enrollment in the vision plan, Superior Vision will send you an ID card. Please present this ID card to your provider. You will continue to use this ID card for the entire period you are covered under this plan. You can print an ID card from the secure member website www.superiorvision.com. The vision plan year runs April 1 through March 31.
| Benefit Outline | Superior Vision | |||
|---|---|---|---|---|
| Network | National Network | |||
| Eligibility | FTE Working ≥ 30 HPW | |||
| Benefits | In Network | Out of Network Allowance | ||
| Eye Exam | $10 copay | Ophthalmologist - Up to $44 Optometrist - Up to $39 | ||
| Materials (eyeglass lenses & frames) | $10 copay | Included in Allowance | ||
| Contact Lens Fitting (Standard) | $10 copay (Standard fit) $50 Allowance (Specialty fit) | Not Covered | ||
| Lenses | ||||
| Single | 100% after copay | Up to $26 | ||
| Bifocal | 100% after copay | Up to $34 | ||
| Trifocal | 100% after copay | Up to $50 | ||
| Materials | ||||
| Frames | $175 Allowance; 20% Off Balance | Up to $70 | ||
| Contacts (in lieu of Lens & Frames) | #colspan | |||
| Elective | $175 Allowance | Up to $100 | ||
| Lasik Surgery Discount | Included | N/A | ||
| Benefit Frequencies Exam Frames Contact lens fitting Eyeglass lenses Contact lenses |
1 per plan year 1 per plan year 1 per plan year 1 pair per plan year 1 allowance per plan year |
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| Please see the benefit summary for additional coverage details | ||||
Vision Benefit Sheet
