Check the service frequency.
See how often the plan covers exams, lenses, frames and contact lenses before choosing an option.
EMPLOVA BENEFITS
Vision Plans
UNDERSTANDING YOUR VISION COVERAGE
Match the plan to how you use vision care.
The right option depends on more than the exam copay. Compare how often you can receive services and the allowances for frames, lenses and contacts.
4vision plan designs
Compare the allowances.
Frame and contact-lens allowances determine how much of your preferred products the plan may cover.
Consider how you buy eyewear.
If you use both contacts and glasses, the available two-pair benefit may be especially important.
VISION PLAN DESIGNS
Focus on the allowances that matter.
Compare exam and lens copays, frames, contacts and service frequency across four vision options.
4vision options
BenefitAll amounts shown per plan
$100 allowanceVision LowVision
$150 allowanceVision Medium 1010Vision
$300 allowanceVision High 510Vision
$350 allowanceVision UltraVision
Eye exam
$10 copay / OON $45
$10 copay / OON $45
$5 copay / OON $45
$5 copay / OON $45
Lenses in-network
$25 copay
$10 copay
$10 copay
$10 copay
Lenses OON allowance
Single $30 · Bifocal $50 · Trifocal $65 · Lenticular $100
Single $30 · Bifocal $50 · Trifocal $65 · Lenticular $100
Single $30 · Bifocal $50 · Trifocal $65 · Lenticular $100
Single $30 · Bifocal $50 · Trifocal $65 · Lenticular $100
Frames allowance
$100 allowance plus additional 20% off any amount over allowance / OON $55 allowance
$150 allowance plus additional 20% off any amount over allowance / OON $70 allowance
$300 allowance plus additional 20% off any amount over allowance / OON $70 allowance
$350 allowance plus additional 20% off any amount over allowance / OON $70 allowance
Elective contact lenses allowance
$100 / OON $80
$150 / OON $105
$300 / OON $105
$350 / OON $105
Medically necessary contact lenses
$25 copay / OON $210
$10 copay / OON $210
$10 copay / OON $210
$10 copay / OON $210
Frequency of services
Eye exam, lenses and contacts: 1 every 12 months · Frames: 1 every 24 months
Eye exam, lenses, frames and contacts: 1 every 12 months (contacts instead of glasses)
Eye exam, lenses, frames and contacts: 1 every 12 months (contacts instead of glasses)
Eye exam, lenses, frames and contacts: 1 every 12 months
2 Pair Rider
—
—
—
$350 to each frames and contacts or $700 to one
Vision Low
- Eye exam
- $10 copay / OON $45
- Lenses in-network
- $25 copay
- Lenses OON allowance
- Single $30 · Bifocal $50 · Trifocal $65 · Lenticular $100
- Frames allowance
- $100 allowance plus additional 20% off any amount over allowance / OON $55 allowance
- Elective contact lenses allowance
- $100 / OON $80
- Medically necessary contact lenses
- $25 copay / OON $210
- Frequency of services
- Eye exam, lenses and contacts: 1 every 12 months · Frames: 1 every 24 months
- 2 Pair Rider
- —
Vision Medium 1010
- Eye exam
- $10 copay / OON $45
- Lenses in-network
- $10 copay
- Lenses OON allowance
- Single $30 · Bifocal $50 · Trifocal $65 · Lenticular $100
- Frames allowance
- $150 allowance plus additional 20% off any amount over allowance / OON $70 allowance
- Elective contact lenses allowance
- $150 / OON $105
- Medically necessary contact lenses
- $10 copay / OON $210
- Frequency of services
- Eye exam, lenses, frames and contacts: 1 every 12 months (contacts instead of glasses)
- 2 Pair Rider
- —
Vision High 510
- Eye exam
- $5 copay / OON $45
- Lenses in-network
- $10 copay
- Lenses OON allowance
- Single $30 · Bifocal $50 · Trifocal $65 · Lenticular $100
- Frames allowance
- $300 allowance plus additional 20% off any amount over allowance / OON $70 allowance
- Elective contact lenses allowance
- $300 / OON $105
- Medically necessary contact lenses
- $10 copay / OON $210
- Frequency of services
- Eye exam, lenses, frames and contacts: 1 every 12 months (contacts instead of glasses)
- 2 Pair Rider
- —
Vision Ultra
- Eye exam
- $5 copay / OON $45
- Lenses in-network
- $10 copay
- Lenses OON allowance
- Single $30 · Bifocal $50 · Trifocal $65 · Lenticular $100
- Frames allowance
- $350 allowance plus additional 20% off any amount over allowance / OON $70 allowance
- Elective contact lenses allowance
- $350 / OON $105
- Medically necessary contact lenses
- $10 copay / OON $210
- Frequency of services
- Eye exam, lenses, frames and contacts: 1 every 12 months
- 2 Pair Rider
- $350 to each frames and contacts or $700 to one
Table key
- D
- The deductible applies before the plan begins paying for the service.
- C
- Coinsurance applies to the service.
- D&C
- The deductible and coinsurance apply.
- AD
- The listed benefit applies after the deductible.
- OON
- Out-of-network. Costs and reimbursement may differ from in-network care.
- UCR
- Usual, customary and reasonable reimbursement methodology.
- Mdcr
- Reimbursement shown as a percentage of the Medicare rate.