PESG Vision Benefits

Below you will find the benefits for our Vision Insurance program along with their applicable rates. If you need to view/print an application then please click here.

Benefit	Network1	Out-of-Network2
Eye Examination	100%	Up to $35
--Single Vision	100%	Up to $25
--Bifocal	100%	Up to $40
--Trifocal	100%	Up to $55
--Lenticular	100%	Up to $55
Frames	100% 3	Up to $45
Elective Contact Lenses 4
--Covered-in-full Contacts	100%	Up to $64
--All other elective contacts	Up to $105	Up to $64
Necessary Contact Lenses 5	100%	Up to $200

1) Network Benefits - $10 Exam and $10 materials copays and patient options are paid to the network provider by the plan participant. Covered Lens options include: Scratch resistant coating, tints and UV. Exams, lenses and frames are covered once every 12 months from last date of service.

2) Out-of-Network Benefits - The plan participant pays full fee to the provider and Spectera reimburses the participant for services rendered up to maximum allowance. There are no copays or deductibles.

3) Frame Benefit -With Spectera's frame benefit, all frames with a $50 wholesale cost or less are covered-in-full at private practice providers. For any frame with a wholesale cost greater than $50 at private practice providers, the participant only pays the difference between the wholesale cost of the frame and the $50 allowance. Plan participants receive a minimum $130 frame allowance for frames purchased at retail chain providers.

4) Contact lenses are provided in lieu of spectacle lenses and frames. Spectera's contact lens benefit covers in-full (after applicable copay) the fitting/evaluation fees, contacts (disposable contacts/up to 4 boxes, depending on prescription and plan selected), and up to two follow-up visits. A $125 allowance is applied toward the fitting/evaluation fees and purchase of contact lenses outside of Spectera's covered-in-full contacts (materials copay does not apply). Toric, gas permeable, and bifocal contacts are all examples of contacts that are outside of our covered-in-full selection.

5) Necessary contact lenses are determined at the provider's discretion for one or more of the following conditions: Following cataract surgery; To correct extreme vision problems that cannot be corrected with spectacle lenses; With certain conditions of anisometropia; With certain conditions of keratoconus.

Monthly Vision Prices
Single:	$9.73
Double:	$18.60
Family:	$24.82