HumanaVision Voluntary Vision Care Plan

EyeMed Network. HumanaVision

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If you use an IN-NETWORK provider (Member cost) $10 Up to $39. Up to $55 10% off retail. $130 allowance 20% off balance over $130

SGB0165A Humana Vision 130 TEXAS Ft. Worth ISD IN-NETWORK provider (Member cost) OUT-OF-NETWORK provider (Reimbursement) $10 Up to $39 Up to $30 Standard contact lens fit and follow-up Premium contact

If you use an IN-NETWORK provider (Member cost) $10 Up to $39. Up to $55 10% off retail. $150 allowance 20% off balance over $150

SGB0168A Humana Vision 130 FLORIDA Vision care services Exam with dilation as necessary Retinal imaging 1 Contact lens exam options2 Standard contact lens fit and follow-up Premium contact lens fit and

If you use an IN-NETWORK provider (Member cost) $10 Up to $39. Up to $55 10% off retail. $130 allowance 20% off balance over $130

SGB0169A Humana Vision 130 FLORIDA Vision care services Exam with dilation as necessary Retinal imaging 1 Contact lens exam options2 Standard contact lens fit and follow-up Premium contact lens fit and

Your Vision Benefits Indian River State College

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Your Vision Benefits Orange County BOCC

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If you use an IN-NETWORK provider (Member cost) $10 Up to $39. Up to $55 10% off retail. 20% off balance over $130

SGB0151A Humana Vision 130 TEXAS Vision care services Exam with dilation as necessary Retinal imaging 1 Contact lens exam options2 Standard contact lens fit and follow-up Premium contact lens fit and follow-up

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Your Vision Benefits Bay District Schools

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STEPS YOU ARE REQUIRED TO TAKE TO CONTINUE COVERAGE

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Life Care Partners LLC dba Family Home Health Services

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EYEMED VOLUNTARY VISION PLAN SUMMARY PLAN DESCRIPTION

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Coverage to help keep

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Vision Benefit Summary

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Coverage to help keep

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KEY GROUP VISION INSURANCE

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Your Vision Benefits Beaver Motors

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VISION BENEFITS ENROLLMENT GUIDE. Delta Dental, in partnership with EyeMed, brings you DeltaVision flexible, affordable vision insurance.

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Member Doctors are those doctors who have agreed to participate in VSP s Choice Network.

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Premiere Vision Coverage to help keep your vision healthy... and your world in focus

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Premiere Vision Coverage to help keep your vision healthy... and your world in focus

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Premiere Vision. Vision Coverage for Seniors

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A COMPLETE VISION INSURANCE PORTFOLIO FROM COMPANION LIFE

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Premiere Vision Coverage to help keep your vision healthy... and your world in focus

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GUIDE ENROLLMENT VISION BENEFITS EAU CLAIRE AREA SCHOOL DISTRICT

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Premiere Vision Coverage to help keep your vision healthy... and your world in focus

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Vision Coverage. Premiere Vision. Coverage to help keep your vision healthy and your world in focus. SureBridgeInsurance.com CH PR VIS FL 319

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Premiere Vision. Vision Coverage for Seniors

Vision Coverage for Seniors Premiere Vision Get vision coverage that can offer you savings on vital eye care, including exams and prescription glasses, benefits that are not included in your Original Medicare

Premiere Vision. Vision Coverage for Seniors

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guide enrollment vision benefits Eau Claire County

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Please see the ISMA Anthem Blue View Vision Low Plan and High Plan flyers for benefit details.

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Vision Insurance - Gold. Enrollment brochure Freedom to choose any vision care provider

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Premiere Vision Coverage to help keep your vision healthy... and your world in focus

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Premiere Vision. Vision Coverage for Seniors

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Vision plans Broker information for groups with 1 to 100 employees

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VISION PLAN PROVISIONS

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40 % 20 % ICUBA Base Plan. Additional discounts. Take a sneak peek before enrolling SUMMARY OF BENEFITS

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Vision Program. Effective January 1, Introduction How the Program Works... 2

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Vision Plan Proposal

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OUT OF NETWORK IN NETWORK

Humana Vision Plans Routine eye exam 100 130/Materials Only 130 160/Materials Only 160 200 Exam with dilation, as necessary* $10 Up to $30 $10 Up to $30 $10 Up to $30 $0 Up to $30 Retinal imaging 1 Up

UnitedHealthcare Vision

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CLEAR VISION FLORIDA. The Clear Choice for Group Vision Plans. For Groups of Eligible Lives. DIR BEN NATL BRCH vision 6/16

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EASTERN VISION SERVICE PLAN, INC. AMENDMENT TO GROUP VISION CARE POLICY PLEASE ATTACH TO YOUR GROUP VISION CARE POLICY

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Important Questions Answers Why this Matters:

This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.vsp.com or by calling 1-800-877-7195. Important Questions

SCHEDULE OF BENEFITS Signature Plan B

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The Company offers the VSP Vision Plan. VSP provides the following benefits.

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Balanced Care VisionSM. Choice. Options to Help Your Employees Stay Focused at Work

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Your Vision PLUS Plan 140. Vision PLUS Plan Summary Chart 141. How the Plan Works 142. What s Covered 143. What s Not Covered 143

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Group Vision Care Policy

Group Vision Care Policy Vision Care for Life Group Name: CITY OF BILLINGS Group Number: 30016484 Effective Date: JANUARY 1, 2014 EVIDENCE OF COVERAGE Provided by: VISION SERVICE PLAN INSURANCE COMPANY

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Vision. Save Money with Spending Accounts

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Deductible then 50% co-insurance Professional Services Primary care provider (PCP) Office and home visits

Provider Network: BrightPath Medical Schedule of Benefits BrightIdea Value Silver 3600 (87) Annual Deductible Per Person, Per Calendar Year Per Family, Per Calendar Year Participating Providers $1,100

RETIREE BENEFITS 2018 INSURANCE BENEFITS GUIDE

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Co-payment $6.50 Exam / $18 Lenses *Standard Lens Allowance is included. **Pre-approval from NVA required Iwf607 Schedule of Vision Benefits NVA2 Participating Provider Examination Once Every Plan Year

Service Participating Providers: Non-participating Providers:

Lane Community College Provider Network: SmartChoice Current LCC Plans Modified Ded, OOP, Copay SC Plan C Medical Benefit Summary SmartChoice 1200+30_20 S3 Annual Deductible Per Person, Per Calendar Year

2019 Annual Open Enrollment Form for Dental Coverage

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Benefit Frequency Copay Coverage from a VSP Network Doctor Out-of-Network Reimbursement. $10 Covered in full Up to $50

Vision Plan Vision Benefits At-A-Glance Type of Plan Who Pays the Cost Employee Eligibility Enrollment Period Plan Information Vision Plan for all eligible employees You share the cost of vision care coverage

Client Vision Care Policy

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Vision. The Citigroup Vision Benefit Plan (the Vision Plan ) offers a variety of routine vision care services and supplies.

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Social Security Number: Last Name (Subscriber): First Name: DOB: Sex: Home Address: City: State: Zip Code: Date of Birth

DELTA DENTAL Delta Dental Plan of Massachusetts Group Name: MCO H&W Fund MCO Health and Welfare Fund DENTAL/VISION ENROLLMENT FORM & PAYROLL DEDUCTION AUTHORIZATION FAX: 603-647-4668 PH: 800-346-4935 E-MAIL:

Service Participating Providers: Non-participating Providers:

Provider Network: PSN PSGBS.ID.SG.MED.PPO.0116 Medical Benefit Summary PSN Balance Silver 4000 VH Annual Deductible Per Person, Per Calendar Year Per Family, Per Calendar Year Participating Providers $4,000

Disclosure Statement and Evidence of Coverage

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Group Vision Care Plan

Group Vision Care Plan Vision Care for Life Group Name: CITY OF BILLINGS Group Number: 30016484 Effective Date: JANUARY 1, 2018 EVIDENCE OF COVERAGE Provided by: VISION SERVICE PLAN INSURANCE COMPANY 3333

Employee. Benefits Plan Plan Year: October 1, September 30, 2017 Arranged and Enrolled by Mark III Brokerage, Inc.

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Service Participating Providers: Non-participating Providers: Medical Schedule of Benefits BrightIdea Balance Silver 2500 (73)

Provider Network: BrightPath Medical Schedule of Benefits BrightIdea Balance Silver 2500 (73) Annual Deductible Per Person, Per Calendar Year Per Family, Per Calendar Year Participating Providers $2,300

Client Vision Care Policy

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CCPOA RETIRED VISION PLAN

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FLEXIBLE BENEFITS PLAN

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Medical Benefit Summary SmartAlliance Silver HSA 3600

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