Vision Plan Benefits for HPS Mechanical, Inc.

Transcription

1 Benefits Vision Plan Benefits for HPS Mechanical, Inc. Co-Pays Services/Frequency Exam $10 Exam 12 months Materials 1 $25 Frame 24 months Contact Lens Fitting $25 Contact Lens Fitting 12 months (standard & specialty) Lenses 24 months Contact Lenses 24 months (Based on date of service) In-Network Out-of-Network Exam (Ophthalmologist) Covered in full Up to $40 retail Exam (Optometrist) Covered in full Up to $30 retail Frames $150 retail allowance Up to $72 retail Contact Lens Fitting (standard 2 ) Covered in full Not covered Contact Lens Fitting (specialty 2 ) $50 retail allowance Not covered Lenses (standard) per pair Single Vision Covered in full Up to $32 retail Bifocal Covered in full Up to $42 retail Trifocal Covered in full Up to $58 retail Progressive (standard) 3 Covered in full Up to $42 retail Factory Scratch Coat Covered in full Not covered Polycarbonate for dependent children Covered in full Not covered Contact Lenses 4 $150 retail allowance Up to $100 retail Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements 1 Materials co-pay applies to lenses and frames only, not contact lenses 2 See your benefits materials for definitions of standard and specialty contact lens fittings 3 Covered to provider s in-office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co-pay 4 Contact lenses are in lieu of eyeglass lenses and frames benefit Discount Features Look for providers in the Provider Directory who accept discounts, as some do not; please verify their services and discounts (range from 10%-40%) prior to service as they vary. Discounts on Covered Materials Frames: Lens options: Progressives: 20% off amount over allowance 20% off retail 20% off amount over retail lined trifocal lens, including lens options The following options have out-of-pocket maximums 5 on standard (not premium, brand, or progressive) lenses. Maximum Member Out-of-Pocket Single Vision Bifocal & Trifocal Scratch coat $13 $13 Ultraviolet coat $15 $15 Tints, solid or gradients $25 $25 Anti-reflective coat $50 $50 Polycarbonate $40 20% off retail High index 1.6 $55 20% off retail Photochromics $80 20% off retail Discounts on Non-Covered Exam and Materials Exams, frames, and prescription lenses: Lens options, contacts, other prescription materials: Disposable contact lenses: 30% off retail 20% off retail 10% off retail 5 Discounts and maximums may vary by lens type. Please check with your provider. Superior Vision Services, Inc. P.O. Box 967 Rancho Cordova, CA SuperiorVision.com The Superior Vision Plan is underwritten by National Guardian Life Insurance Company. National Guardian Life Insurance Company is not affiliated with The Guardian Life Insurance Company of America, AKA The Guardian or Guardian Life NVIGRP BSv2/CA. SuperiorVision.com Customer Service Refractive Surgery Superior Vision has a nationwide network of refractive surgeons and leading LASIK networks who offer members a discount. These discounts range from 5%-50%, and are the best possible discounts available to Superior Vision. The Plan discount features are not insurance. All allowances are retail; the member is responsible for paying the provider directly for all non-covered items and/or any amount over the allowances, minus available discounts. These are not covered by the plan. Discounts are subject to change without notice. Disclaimer: All final determinations of benefits, administrative duties, and definitions are governed by the Certificate of Insurance for your vision plan. Please check with your Human Resources department if you have any questions.

2 the Sam N Johnson OD Eye Exam Business 1234 First Ave. Ste 100, Anywhere, CA (916) View Address Map less than 1 mile Services Offered: Glasses Contacts Contact Lens Fitting Exam Accepts Discounts

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4 Bakersfield Area Providers - March 2014 Member Services Practice Name DName Street Suite City State Zip Telephone Alain H Nguyen Optometry Alain H Nguyen OD 3800 Niles St Ste 2 Bakersfield CA (661) Alain H Nguyen Optometry Alain H Nguyen OD 3880 Gosford Rd Ste 200 Bakersfield CA (661) Bakersfield Eye Care Optometric Center Stan C Yang OD Ming Ave Ste 360 Bakersfield CA (661) Bakersfield Eye Care Optometric Center Son Q Nguyen OD Ming Ave Ste 360 Bakersfield CA (661) Bakersfield Eye Institute David B Hair MD 7508 Meany Ave Bakersfield CA (661) Bakersfield Optical th St Ste 100 Bakersfield CA (661) Boston Eye Care Joseph F Figazolo OD 600 Coffee Rd Ste H Bakersfield CA (661) Camino Media Eye Care & Optical Botique Carole A Casteen MD 1026 Calloway Dr Ste 200 Bakersfield CA (661) Central Valley Eye Care Hosein Mohammadi MD 5000 Physicians Blvd Ste 100 Bakersfield CA (661) Central Valley Eye Care Steven J Soong OD 5000 Physicians Blvd Ste 100 Bakersfield CA (661) Central Valley Eye Care Ali Banihashemi MD 5000 Physicians Blvd Ste 100 Bakersfield CA (661) David R King OD David R King OD 1046 Whitley Ave Corcoran CA (559) Devlyn Optical 2100 White Ln Bakersfield CA (661) Dr (Rick) Yong J Park OD next to Sam's Club Yong J Park OD 5625 Gosford Rd Bakersfield CA (661) Dr (Rick) Yong J Park OD next to Walmart Yong J Park OD 6225 Colony St Bakersfield CA (661) Dr Robert D Gillett OD Robert Gillett OD 418 W Putman Ave Porterville CA (559) Drs Li Liao and Uminisky Ods Barry Uminsky OD 1002 Wible Rd Ste I Bakersfield CA (661) Drs Li Liao and Uminisky ODs Yuh-Jen Liao OD 1002 Wible Rd Ste I Bakersfield CA (661) Drs Li Liao and Uminisky ODs Eileen Y Ng OD 1002 Wible Rd Ste I Bakersfield CA (661) Drs Li Liao and Uminisky ODs Dawson T Li OD 1002 Wible Rd Ste I Bakersfield CA (661) Drs Li Liao and Uminisky Ods Dawson T Li OD Main St Lamont CA (661) Drs Li Liao and Uminsky Ods Dawson T Li OD 9820 Brimhall Rd Bakersfield CA (661) Drs Li Liao and Uminsky Ods Yuh-Jen Liao OD 9820 Brimhall Rd Bakersfield CA (661) Drs Li Liao and Uminsky Ods Barry Uminsky OD Main St Lamont CA (661) Drs Li Liao and Uminsky Ods Yuh-Jen Liao OD Main St Ste E Lamont CA (661) Eyemart Express 3216 Ming Ave Ste D Bakersfield CA (661) FirstSight Vision Services Martin L Hetland OD 8400 Rosedale Hwy Bakersfield CA (661) FirstSight Vision Services Rick Park OD 8400 Rosedale Hwy Bakersfield CA (661) FirstSight Vision Services Salma Hasnain OD 8400 Rosedale Hwy Bakersfield CA (661) FirstSight Vision Services Glenn Matoba OD 8400 Rosedale Hwy Bakersfield CA (661) FirstSight Vision Services Barbara Portillo OD 8400 Rosedale Hwy Bakersfield CA (661) FirstSight Vision Services Richard Hom OD 1110 E Prosperity Ave Tulare CA (559) FirstSight Vision Services Yu-Ho Cheng OD 1110 E Prosperity Ave Tulare CA (559) Fritch Eye Care Medical Center Jane Y Li OD 8501 Brimhall Rd Ste 402 Bakersfield CA (661) Fritch Eye Care Medical Center Charles D Fritch MD 8501 Brimhall Rd Ste 402 Bakersfield CA (661) Fritch Eye Care Medical Center Dale A Young OD 8501 Brimhall Rd Ste 402 Bakersfield CA (661) Garrick K Peterson OD Garrick K Peterson OD 141 S Mirage Ave Lindsay CA (559) Gary L Williams OD Gary L Williams OD 4900 Commerce Dr Bakersfield CA (661) Golden State Eye Medical Group Greg W Kaiser OD 1001 Tower Way Ste 150 Bakersfield CA (661) Golden State Eye Medical Group Janet K Kim MD 1001 Tower Way Ste 150 Bakersfield CA (661) Golden State Eye Medical Group Paul L Mikailian OD 1001 Tower Way Ste 150 Bakersfield CA (661) Gregory Stainer MD John T Lindquist OD 215 China Grade Loop Bakersfield CA (661) Gregory Stainer MD Glenn A Kaprielian OD 215 China Grade Loop Bakersfield CA (661) Gregory Stainer MD Gregory A Stainer MD 215 China Grade Loop Bakersfield CA (661) Gregory Stainer MD Jack Groves OD 215 China Grade Loop Bakersfield CA (661) Hernake Takhar OD next to Walmart Hernake S Takhar OD 2601 Fashion Pl Bakersfield CA (661) Innovative Eye Care Optometric Cheree A Wilhelmsen OD 4903 Calloway Dr Ste 101 Bakersfield CA (661) isee Optometry Anh-Thu T Huynh OD 5625 Gosford Rd Bakersfield CA (661) isee Optometry Lam H Votran OD 5625 Gosford Rd Bakersfield CA (661) Jack D Groves OD Jack D Groves OD 550 Central Ave Shafter CA (661) James L Simonson OD James L Simonson OD 417 Center St Taft CA (661) Jane Li OD inside Sears Optical Jane Y Li OD 3001 Ming Ave Bakersfield CA (661) JCPenney Optical 2501 Ming Ave Bakersfield CA (661) John E Fagan Jr OD John E Fagan OD Valley Blvd Ste G Tehachapi CA (661) John L Knight OD John L Knight OD 700 H St Bakersfield CA (661) John Lindquist OD John T Lindquist OD 3869 Stockdale Hwy Bakersfield CA (661) Joy Carino Kimpo Community Health Center Douglas C Reber OD 1001 Main St Delano CA (661) Kai W Wong MD Kai W Wong MD th St Ste 501 Bakersfield CA (661) Ken's Optical 2022 N Chester Ave Bakersfield CA (661) Larry DeDonato OD Larry M DeDonato OD 1429 Main St Delano CA (661) LensCrafters 2724 Ming Ave Bakersfield CA (661) Li and Liao Optometry Eileen Y Ng OD 9820 Brimhall Rd Bakersfield CA (661) Louis C Allen OD Louis C Allen OD 1811 Oak St Ste 150 Bakersfield CA (661) National Health Services 320 James St Shafter CA (661) National Vision Center in Walmart 8400 Rosedale Hwy Bakersfield CA (661)

5 Practice Name DName Street Suite City State Zip Telephone National Vision Center in Walmart 1110 E Prosperity Ave Tulare CA (559) North Chester Optometry Casey J Finn OD 2022 N Chester Ste B Bakersfield CA (661) Oildale Community Health Center Douglas C Reber OD 525 Roberts Ln Bakersfield CA (661) Optical Eyewear th St Ste 103 Bakersfield CA (661) Optometrist inside Target Optical Rosedale Hwy & Main Plaza Bakersfield CA (661) Optometrist inside Target Optical 2195 E Prosperity Ave Tulare CA (559) Park Family Optometric Center Mark J Park OD th Ave Delano CA (661) Phillip Polster OD next to Walmart Phillip Polster OD 1250 W Henderson Ave Porterville CA (559) Premier Eye Care Optometric Center Cache M Crawford OD 3911 Coffee Rd Ste B Bakersfield CA (661) Premier Eyecare Optometric Center John F Hawley OD 3911 Coffee Rd Ste B Bakersfield CA (661) Sam's Club Optical 5625 Gosford Rd Bakersfield CA (661) Sears Optical 3001 Ming Ave Bakersfield CA (661) Son Nguyen OD Son Q Nguyen OD 9100 Rosedale Hwy Bakersfield CA (661) Southwest Eye Care Glenn A Kaprielian OD 4649 Planz Rd Bakersfield CA (661) Southwest Eye Care Gregory A Stainer MD 4649 Planz Rd Bakersfield CA (661) Southwest Eye Care and Laser Janae L Vance OD 4649 Planz Rd Bakersfield CA (661) Southwest Eye Care and Laser Keith C Miller OD 4649 Planz Rd Bakersfield CA (661) Southwest Eye Care and Laser Jane Y Li OD 4649 Planz Rd Bakersfield CA (661) Spencer & Suorsa Timothy P Suorsa OD 524 W Putnam Ave Porterville CA (559) Stan C Yang OD Stan C Yang OD 9100 Rosedale Hwy Bakersfield CA (661) Stanton Optical Chinyere J Udonsi OD 4492 Ming Ave Bakersfield CA (661) Stanton Optical 4492 Ming Ave Bakersfield CA (561) Stephen D Ratty OD Fred Narzisi OD 2222 "E" St Ste 1 Bakersfield CA (661) Stephen D Ratty OD Stephen D Ratty OD 2222 "E" St Ste 1 Bakersfield CA (661) Sterling VisionCare Glenn Matoba OD 3216 Ming Ave Ste D Bakersfield CA (661) Sterling VisionCare Casey Finn OD 3216 Ming Ave Ste D Bakersfield CA (661) Sterling VisionCare Duy Pham OD 3216 Ming Ave Ste D Bakersfield CA (661) Steven Leibowitz MD Steven Leibowitz MD 5301 Truxton Ave Ste 200 Bakersfield CA (661) Stockdale Optical 5466 California Ave Bakersfield CA (661) Stockdale Optometry Duyen B Le OD 3869 Stockdale Hwy Bakersfield CA (661) Stockdale Optometry Ranjeet S Bajwa OD 3869 Stockdale Hwy Bakersfield CA (661) Syed S Hasnain MD Syed S Hasnain MD 560 W Putnam Ave Ste 6 Porterville CA (559) Taft Community Health Center Douglas C Reber OD 1100 Fourth St Taft CA (661) Target Optical 9100 Rosedale Hwy Bakersfield CA (661) Tehachapi Optometric Center Boyd F Young OD Valley Blvd Tehachapi CA (661) The Optical Shoppe of Bakersfield 1603 California Ave Ste 103 Bakersfield CA (661) Thurman Edward Wood OD Thurman E Wood OD 4819 Calloway Dr Ste 101 Bakersfield CA (661) Triangle Eye Institute Mona Gill OD 9700 Brimhall Rd Bakersfield CA (661) Triangle Eye Institute Steven Yaplee MD 9700 Brimhall Rd Bakersfield CA (661) Valley Medical Group of Kern County Mona K Gill OD 5400 Aldrin Ct Bakersfield CA (661) Wallace E Ruminson MD Wallace E Ruminson MD 444 W Putnam Ave Porterville CA (559) Walmart Vision Center 2601 Fashion Pl Bakersfield CA (661) Walmart Vision Center 6225 Colony St Bakersfield CA (661) Walmart Vision Center 530 Woollomes Ave Delano CA (661) Walmart Vision Center 1250 W Henderson Ave Porterville CA (559) Wasco Community Health Center Douglas C Reber OD th St Wasco CA (661) William F Adkins OD William F Adkins OD 1340 E Prosperity Ave Tulare CA (559) Wolfgang Renken OD Wolfgang Renken OD th St Wasco CA (661)

6 Get 25% Off Designer Eyewear Online! Superior Vision has partnered with DITTO.com to give members exclusive online discounts on their extra pairs of sunglasses, prescription glasses, and prescription sunglasses. Go to 25% off single pair purchases Cutting-edge virtual try-on 30% off two or more pairs Free shipping and returns Exclusive 2-year warranty 35 top brands including Ray-Ban *DITTO.com is an out-of-network partner; members may be reimbursed for prescription materials at out-of-network rates. Reimbursement forms are available at SuperiorVision.com. Offers not valid with any other promotion.