Superior Vision
The Visible Difference in Managed Vision Care
Presenting the Superior Vision Plan
State of Oklahoma
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
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
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
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
Unparalleled Providers.
Memorable Service.Superior Choice.
Thank You.
We Look Forward to Providing You With Superior Service.
Top Related