Us-Based Medical Benefits - Plan Comparison Chart Page 3
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2
3VISION CARE
100%
100% after $20
100% after $15
80%
$40.00 allowance
Eye Exam
1 exam every
co-pay
co-pay
1 exam every
1 exam every 12 months
12 months
1 exam every
1 exam every
12 months
12 months
12 months
$45 every
Save up to 65% at
$130 allowance
80%
$45 for frames
Frames and
24 months for
participating
then 20%
up to $100 per year
$25/pair single vision
Optical Lenses
frames and lenses
centres
discount on
$40/pair Bifocal lenses
from select group
remaining
$55/pair Trifocal lenses
balance for
(amounts listed are
frames, $10 co-
allowances provided by
pay for lenses
insurance)
OTHER BENEFITS
Physical and other
100%
100%
100%
80%
80% after deductible
Inpatient Therapy
90 visits
60 visits
60 visits
100%
100%
100% after $20
80% after deductible
80% after deductible
Physical and other
90 visits
co-pay
60 visits
Outpatient
60 visits
Therapy
100%
100%
100%
80%
Not covered
Durable Medical
Equipment
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