City of Lewisville, TX
Home MenuVision Benefits
The vision benefit is a fully insured vision benefit provided through Superior Vision. The Superior Vision plan pays first dollar for your vision claims. For the highest level of benefits please use an in-network provider. The City of Lewisville participates in the Superior Select Southwest Network.
Vision Premiums
| per month |
|
|---|---|
| employee only |
$ 0.00 |
| employee + spouse |
$3.75 |
| employee + child(ren) |
$3.65 |
| employee + family |
$8.05 |
| Benefits | in-network | out-of-network |
|---|---|---|
|
Vision Exam: |
||
| Exam with Dilation | $15 copay | $35 allowance |
| Lenses: | ||
|
Single Bifocal Trifocal |
$20 copay; then 100% $20 copay; then 100% $20 copay; then 100% |
$25 allowance $40 allowance $45 allowance |
| Contact Lenses: | ||
|
Elective Medically Necessary |
$125 allowance $20 copay; then 100% |
$80 allowance $150 allowance |
| Frequency: | ||
|
Examination Lenses or Contact Lenses Frame |
Once every 12 months Once every 12 months Once every 12 months |
Once every 12 months Once every 12 months Once every 12 months |