91Ô­´´

Eligibility

Full and part-time benefit-eligible faculty, staff and retirees who meet 91Ô­´´ age and service requirements

Plan Year is the period July 1 through June 30.

Plan Administrator

Ìý(Sponsor # 51942000001)

Who Can Use this Benefit

Employee, spouse, eligible dependent child(ren)

Benefit

Service

Frequency*

Benefits In-Network

Benefits Out-of-Network

Comprehensive Eye Exam

Once every plan year

Covered after $15 co-pay

Up to $50

Standard Lenses

Once every plan year

Covered in full

Single Vision up to $40
Bifocal up to $60
Trifocal up to $80
Lenticular up to $100

Frames

Once every two plan years

Up to $150 Retail**
(20% discount off remaining balance over $150 allowance.Ìý Discount does not apply at Wal-Mart/Sam's Club locations.)

Up to $80

Contact Lenses

Once every plan year in lieu of lenses/frames

Up to $120 Retail**
(15% discount (conventional) or 10% discount (disposable) off remaining balance over $120.Ìý Discounts do not apply at Wal-Mart/Sam's Club locations or Contact Fill mail orders.)

Up to $120

Medically Necessary (pre-approval from NVA required)

Covered in full

Up to $225

Contact Lens Evaluation/Fitting (only covered if you choose contact lenses)

Covered in full

Daily Wear $20
Extended Wear $30

*Plan Year is the period July 1 through June 30.

**The insured is responsible for paying any charges in excess of this allowance.

Costs

Through the flexible benefits program, the University provides Flex Credit to cover the premium for full-time employees. Benefits for dependents and retirees are voluntary and available at an additional group-rate cost.

Spousal Coordination

Not applicable to this benefit

NVA Value-Added Programs

Online shopping with UVP: Learn more

• 6,000+ frame options with virtual try-on technology
• Free shipping and hassle free returns

Laser refractive surgery discount program-Lasik®

• Over 600 provider locations nationwide; free consultation with in-network providers

• Ìý$800 savings at featured providers Ìý ÌýÌý

Mail order contacts lens replacement program - Contact Fill®

• Low prices, dependable service, brand names shipped to members’ homes

• In-network benefit - no claim form required

Hearing discount program - Nations Hearing®

• 30-60% savings on brand name hearing aids/related professional services
• Largest accredited network - providers in all 50 states
• Hearing Aid Flyer

Additional pairs discount program - EYEESSENTAL®

• Significant savings on additional materials purchase

• Unlimited usage throughout the plan year at participating providersÌýÌýÌýÌýÌý