Select Networks ~ Vision Plans

Select Advantage Materials Only Plan

How the Select Advantage Materials Only Plan Works

Select Advantage Materials Only provides standard lenses and frames from a high quality selection that is covered in full after the applicable copay. Or the employee or dependent can choose to receive a generous allowance towards the purchase of contacts in lieu of frames and lenses. This plan works well for a group that already has an eye exam under the groups medical plan.

Schedule of Benefits

Benefit Frequency
	In-Network	Out-of-Network
Standard Lenses (pair)	12 Months	12 Months
Frame	24 Months	24 Months
Contact Lenses	12 Months	12 Months
Benefit Allowance and Reimbursement
	In-Network	Out-of-Network
Standard Lenses - Single Vision	100% after the applicable copayment	Reimbursed up to $25.00
Standard Lenses - Bifocal	100% after the applicable copayment	Reimbursed up to $40.00
Standard Lenses - Trifocal	100% after the applicable copayment	Reimbursed up to $50.00
Standard Lenses - Lenticular	100% after the applicable copayment	Reimbursed up to $80.00
Frame	Covered 100%, within the plan allowance after the applicable copayment	Reimbursed up to $45.00
Contact Lenses - Elective*	100% up to the plan allowance	Reimbursed up to $130.00
Contact Lenses - Medically Necessary*	Covered in full	Reimbursed up to $250.00
Additional purchases, or add-ons to standard lenses *	20% off the providers retail	N/A

*A $10 Copayment is for the vision exam only. A $10/$10 or $10/$15 includes a $10 Copayment for the vision exam and a $10 or $15 copayment for materials.

Rates are guaranteed for two (2) years.

The vision plan requires a minimum participation of ten (10) eligible employees.

Employer Paid rates need particpation of 100% of eligible employees, 10 lives minimum.

Each employee enrolling in the Group Vision Plan must agree to remain enrolled during the designated plan period.

Those employees who elect not to enroll during the initial plan enrollment period must wait until the next plan enrollment period to enroll. The plan enrollment period shall be the month prior to the beginning of the next plan year.

New employees who elect coverage in the Group Vision Plan must enroll within thirty (30) days of their date of employment and shall become eligible for coverage on the first day of the month coinciding with the effective date of the employer's group medical plan.

The Advantage Plan is underwritten by Fidelity Security Life Insurance Company, Kansas City, MO; VC-16, M-9004.

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Select Networks · 317 6th Avenue, Suite 1040 · Des Moines, IA 50309-4113
Phone: 515-244-6282 · Toll-Free: 800-797-6282 · info@eyeplan.com