You are on page 1of 1

Vision Plan

Vision Plan Features Coverage Year May 1 Dec 31, 2011 Eye Examination Lenses Single vision Lined bifocal Lined trifocal Lenticular Frames Frequency If Using a VSP Provider If Using a Non-VSP Provider

Once every coverage year Once every coverage year

$10 copay

Covered up to $35 Covered up to: $25 $40 $55 $80 Covered up to $45 Covered up to: $105 $210

$15 copay

$15 copay Once every two coverage years $120 maximum allowance Covered in full $120 maximum allowance

Contact Lenses Elective Visually necessary

Once every coverage year

This overview summarizes some of the main features of the SFN Group, Inc. Health & Welfare Benefit Program. Please note that this overview is merely a summary and it is not intended to replace the official and controlling provisions of the plans or policies. In case of any differences, the official plan documents or policies will always govern over this overview. SFN Group reserves the right to amend, modify, suspend or terminate the plans, policies and programs at any time.

You might also like