ABC Company, Inc.
Effective Date: Xxxxxxx 1, 2006
VISION PERFECT® PLAN HIGHLIGHTS
With the Vision Perfect Plan, each insured individual can select the physician to provide eye care services based on his or her own personal preference. Benefits are reimbursed solely on the scheduled defined amounts of the plan design, so there will be no billing surprises. You will appreciate the freedom to choose your own eye care provider without being penalized.
VISION PERFECT AT-A-GLANCE
PROPOSED MONTHLY RATES
Rates valid for policy effective dates through 1/1/07 and are guaranteed for two years, or to align with Sect 125 plan year.
PLAN REQUIREMENTS
• Employer funding is not required. If no employer money is involved, it is assumed the eye care plan will be sold in conjunction with a bonafide cafeteria plan regulated by Section 125 of the Internal Revenue code, and it must meet all Section 125 requirements.
• The rates and benefits quoted are based on a minimum of 10 enrolled employees and are not valid if the final enrollment is below that minimum threshold.
• No benefits are payable for a service which is not listed under the list of eye care services.
• Benefits available for all full-time, active employees working at least 30 hours per week who have completed the designated waiting period.
VISION PERFECT LIMITATIONS AND EXCLUSIONS
• This quote is not valid in Florida and New York. Please check for availability in your state.
• Covered Expenses will not include, and no benefits will be payable for, expenses incurred for:
1. vision examinations more than once in any twelve-month period.
2. lenses more than once in any twelve-month period.
3. frames more than once in any twenty-four month period.
4. contact lenses more than once in any twelve-month period. When chosen, contact lenses shall be in lieu of any other lens or frame benefit during the twelve-month period. When lenses and frames are chosen, expenses for contact lenses are not Covered Expenses during the twelve-month period.
5. examinations performed or frames or lenses ordered before the Insured was covered under the eye care expense benefits.
6. subject to extension of benefits, any examination performed or frame or lens ordered after the insured’s coverage under the eye care expense benefits ceases.
7. sub-normal eye care aids; orthoptic or eye care training or any associated testing.
8. non-prescription lenses.
9. replacement or repair of lost or broken lenses or frames except at normal intervals.
10. any eye examination or corrective eyewear required by an employer as a condition of employment.
11. medical or surgical treatment of the eyes.
12. any service or supply not shown on the Schedule of Eye Care Procedures.
13. coated lenses; oversize lenses (exceeding 71mm); photo-gray lenses; polished edges; UV-400 coating and facets, and tints other than solid.
14. lenses and frames during the first twelve months that a person is insured under the eye care expense benefits, when the person is a Late Entrant, as defined.