Southern Utah University
852 East Arrowhead Lane
351 West University Blvd.
Murray, Utah 84107-5298
Cedar City, Utah 84720
(801)262-7475 / (800)662-5851
Fax (801)269-9734
Group:
Southern Utah University
Plan:
Vision
Underwritten and Administered by:
Educators Mutual Insurance Association
Plan Type:
Voluntary
7/1/2009
Single Vision
Bifocal
Trifocal
Lenticular
Necessary (Permanent)
Necessary (Disposable)
Examination
Standard Lenses
Contact Lenses (Permanent)
Contact Lenses (Disposable)
Frames
Repair of Damage
Repair of Damage
Over-sized / Over-power lenses
Standard Optical
Examination
Standard Lenses
Frames
Contact Lenses
Other Services
Employee
Employee + One Dependent
Family
EM.VIS.CHT.AK
Up to a maximum of $100.00 per frame
Once every 12 Months
Up to a maximum of $65.00 per lens
Up to a maximum of $75.00 per lens
Up to a maximum of $120.00 per lens
Standard Lenses
Contact Lenses
Frames
Benefits are allowed for one of the following every 24 months: 1. Standard lenses and frames; 2. Permanent contact lenses; or 3. Disposable contact lenses.
These benefits may not be combined.
Notes
Up to a maximum of $50.00
Benefit
Waiting Periods
Examination
Frequency
One repair every 24 Months
None
None
Effective Date:
In Lieu of Contact Lenses
One pair every 24 Months
Up to a maximum of $120.00
Up to a maximum of $50.00 per lens
In Lieu of Standard Lenses and Frames
Services or materials provided by any other group benefit providing for vision care
Benefits illustrated are in summary only. Refer to your Vision handbook for a complete description of benefits, limitations and exclusions.
Other Services
50% of Table of Allowances
Additional 15% of Lens Benefit
Discounts
$11.30
Limitations & Exclusions
35% off all frame and lens merchandise
None
None
$5.60
One pair every 24 Months
One pair every 24 Months
Up to Maximum every 24 Months
Monthly Rates
$16.90
None
Non-prescription lenses and non-prescription sunglasses