Vision Benefit SummariesGroups 51-992025

Forms are in pdf format.

$35 Eyewear Benefit

Vision Care 100: 12/12/12

Vision Care 100: 12/12/12-Voluntary

Vision Care 100: 12/12/24

Vision Care 100: 12/12/24-Voluntary

Vision Care 100: 24/24/24

Vision Care 130: 12/12/12

Vision Care 130: 12/12/12-Voluntary

Vision Care 130: 12/12/24

Vision Care 130: 12/12/24-Voluntary

Vision Care 130: 12/12/24 with Copay

Vision Care 130: 12/12/24 with copay - Voluntary

Vision Care 150: 12/12/12

Vision Care 150: 12/12/12-Voluntary

Vision Care 150: 12/12/24

Vision Care 150: 12/12/24-Voluntary