Vision Benefits

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The vision benefit is a fully insured vision benefit provided through Superior Vision. The Superior Vision plan pays first dollar for your vision claims. For the highest level of benefits please use an in-network provider. The City of Lewisville participates in the Superior Select Southwest Network.

Vision Premiums

 

    PER MONTH   

EMPLOYEE ONLY

 $0.00

EMPLOYEE + SPOUSE

 $3.75

   EMPLOYEE + CHILD(REN)  

 $3.65

EMPLOYEE + FAMILY

 $8.05

 

 

Benefits in-network out-of-network

 Vision Exam:

   
     Exam with Dilation  $15 copay $35 allowance
 Lenses:    

    Single

    Bifocal

    Trifocal

$20 copay; then 100%

$20 copay; then 100%

$20 copay; then 100%

$25 allowance

$40 allowance

$45 allowance

 Contact Lenses:    

    Elective

    Medically Necessary

$125 allowance

$20 copay; then 100%

$80 allowance

$150 allowance

 Frequency:    

    Examination

    Lenses or Contact Lenses

    Frame

Once every 12 months

Once every 12 months

Once every 12 months

Once every 12 months

Once every 12 months

Once every 12 months

 

 

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