Vision
Your vision coverage is provided through Principal. Below are the main highlights of the Principal Vision Plan. For a full summary and description of all covered services, please refer to the Summary of Benefits & Coverage (SBC) at the end of this guide. You can find and search for in-network providers at www.principal.com. Your cost per-pay period for each tier of coverage can be found at the bottom of the page.
| Benefits | In-Network | Out-of-Network | Frequency |
|---|---|---|---|
| Network Name | VSP | N/A | |
| Exam Copay | $10 | Up to $45 | One every 12 months |
| Lenses Copay Single Bifocal Trifocal Lenticular | $25 $25 $25 $25 | Up to $30 Up to $50 Up to $65 Up to $100 | One every 12 months |
| Frames Allowance | $150 | Up to $70 | One every 24 months |
| Contact Lenses Allowance (Elective/Necessary) | Elective: Up to $60 Necessary: $25 copay | Elective: Up to $105 Necessary: Up to $210 | One every 12 months |
| Coverage Tier | Cost per Semi-Monthly |
|---|---|
| Employee Only | $0.00 |
| Employee + Spouse | $1.87 |
| Employee + Child(ren) | $2.33 |
| Family | $4.67 |