Dwellworks 2023 Benefits Guide

VISION - Lincoln COVERAGE OVERVIEW

Under this plan, you may use the eye care professional of your choice. However, when you visit a participating in-network provider, you receive higher levels of coverage. If you choose to receive services from an out-of-network provider, you will be required to pay that provider at the time of service and submit a claim form for reimbursement.

IN-NETWORK (Spectera) PROVIDER

OUT-OF-NETWORK PROVIDER

PLAN FEATURES

Vision Exam

$10 copay

Up to $40

COVERED SERVICES – LENSES / FRAMES

Single Lenses

$10 copay

Up to $40

Bifocals

$10 copay

Up to $60

Trifocals

$10 copay

Up to $80

Frames

$130 retail allowance

Up to $45

COVERED SERVICES

Contact Lenses

$125 retail allowance

Up to $125

Contact Lens Evaluation Fitting

15% off UCR

No discounts

BENEFIT FREQUENCY

Once every 12 Months

Once every 12 Months

Exams

Lenses

Once every 12 Months

Once every 12 Months

Frames

Once every 24 Months

Once every 24 Months

Once every 12 Months (contacts in lieu of frames/lenses)

Once every 12 Months

Contacts

Laser Vision Correction: Free LASIK consultation with in-network providers. Convenient access to experienced LASIK surgeons at more than 900 locations nationwide. Flexible 0% financing options available to qualified applicants. For more information, visit vision.qualsight.com or call 855-250-2020.

Employee Portion (Per pay)

Contributions (24 pays/year) Vision 2023

Dwellworks Portion (Per pay)

Employee

$0.23

$2.31

Employee + Spouse

$2.34

$2.47

Employee + Child(ren)

$2.38

$3.27

Family

$3.77

$4.17

Did you know your eyes can tell an eye care provider a lot about you?

Need to locate a participating In-Network provider? Visit lvc.lft.com, on the left side of the page, use the Provider Quick Search Box then enter Zip Code. Search by location, doctor name, or office name.

In addition to eye disease, a routine eye exam can help detect signs of serious health conditions like diabetes and high cholesterol. This is important, since you won’t always notice the symptoms yourself and since some of these diseases cause early and irreversible damage.

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