superior vision the visible difference in managed vision care presenting the superior vision plan...
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Superior Vision
The Visible Difference in Managed Vision Care
Presenting the Superior Vision Plan
State of Oklahoma
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Benefit Frequency Type In-Network Out-of-Network
Comprehensive Eye Exam
1 per Calendar Year
Does NOT include Contact Lens Fitting exam
Covered in Full after $10 co-pay
M.D. to $34O.D. to $26
Single Vision Lenses 1 Pair per Calendar Year
Standard, Glass, or Plastic Covered in Full after $25 co-pay
Up to $26
Bifocal Lenses 1 Pair per Calendar Year
Standard, Glass, or Plastic; Covered in Full after $25 co-pay
Up to $39
Trifocal Lenses 1 Pair per Calendar Year
Standard, Glass, or Plastic;
Covered in Full after $25 co-pay
Up to $49
Lenticular Lenses 1 Pair per Calendar Year
Standard, Glass, or Plastic;
Covered in Full after $25 co-pay
Up to $78
Frame 1 per Calendar Year
Any frame Up to $125 retail Up to $68
Contact Lenses,* Elective
*Medically Necessary
1 Benefit per Calendar Year
1 Benefit per Calendar Year
Any prescription contacts
Prescription medically necessary contacts
Up to $120, no co-pay
Covered in Full
Up to $100
Up to $210
* Contact lenses are in lieu of eyeglass lenses and frames *20% discount on refractive surgery fee - LASIK, RK, PRK (laser)
Your Vision Benefits
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Superior Network• The Three O’s:
• Ophthalmologists• Optometrists• Opticians
• Can use different providers for exam and materials
• Can nominate an out-of-network provider
• National and regional chains (JCPenney Optical, Pearle Vision, Lenscrafters, Target Optical
Ophthalmologists14%
Optometrists 63%
Opticians &Optical Chains
23%
42,000+ Nationwide
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Online Mail-Order Contact Lenses
• Buy contact lenses online! – Treated as an In-
network contact lenses allowance
– All major brands and types of contacts.
– www.svcontacts.com– Up to 30% discount– No claim forms required– Shipped directly to you
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Customer Service and Benefits Information
Customer Service 800-507-3800
Mon – Fri: 7:00am – 8:00pm CSTSaturday: 10:00am – 3:30pm CSTSunday Closed
www.superiorvision.com
•Individualized benefit information•Individualized eligibility status•Individualized claims information•Provider listings•Assistance with issues and special requests
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Unparalleled Providers.
Memorable Service.Superior Choice.
Thank You.
We Look Forward to Providing You With Superior Service.