Option 1 -  Materials Only

Option 2 -  Exam and Materials

Benefits Frequency

Lenses once every 12 months
Frames once every 12 months
Contacts once every 12 months

Exam once every 12 months
Lenses once every 12 months
Frames once every 12 months
Contacts once every 12 months

Exam - Provided by a network optometrist or ophthalmologist

Not covered

100% covered after a $10 co-pay

Lenses

Clear Single Vision
Clear Lined bifocal
Clear Lined Trifocal
Clear Lenticular

100% covered after a $25 co-pay
Standard scratch coating is covered in full.  A material’s co-pay applies to the entire purchase of eyeglasses (lenses and frames), or contacts in lieu of eyeglasses.

Frames

Selection frames are covered at 100% after a $25 materials co-pay.  Receive a $50 wholesale frame allowance at private practice providers, or a $130-135 frame allowance at retail chain providers.

Contact Lenses

In lieu of eyeglasses, you may select contact lenses.  The fitting/evaluation fees, contacts and up to two visits are covered in full after a $25 co-pay.  Members are eligible to receive 4 boxes of covered disposables or a $110 allowance toward non-selection contact lenses.

Refractive Eye Surgery
(Laser Surgery)

Spectera participants receive access to discounted refractive eye surgery from numerous provider locations throughout the United States.  To find a participating laser eye surgeon in your area, visit our Website at www.spectera.com.

Out-of-Network Benefits

Exam:  Not covered

Exam:  $40 co-pay

Frame:                                $45.00
Single Vision:                    $40.00
Bifocal:                               $60.00
Trifocal:                             $80.00
Lenticular:                         $80.00
Contacts:                           $110.00
Medically Necessary:      $210.00

Frame:                                $45.00
Single Vision:                    $40.00
Bifocal:                               $60.00
Trifocal:                             $80.00
Lenticular:                         $80.00
Contacts:                           $110.00
Medically Necessary:    $210.00

Monthly Vision Premiums

Option 1

Option 2

Employee Only

$ 5.10

$ 6.45

Employee + Spouse

$ 8.78

$ 11.63

Employee + Child

$ 8.36

$ 11.08

Family

$ 12.87

$ 16.17

For office locations:  www.spectera.com

Enrollment form:    www2.gsu.edu/~wwwhre/benefits/EnrollmentForms/VisionEnroll.pdf