Onion Benefits Guide 2024 FINAL

VISION

BENEFIT

IN-NETWORK

OUT-OF-NETWORK

Eye Exam

$10

Up to $40

Materials

$25

Per Allowance Schedule

Frequency Exam

12 months 12 months 24 months 12 months

Lenses Frames Contacts (in lieu of eyeglasses)

Frames Private practice provider Retail Chain provider

$130 retail allowance $130 retail allowance 30% discount over allowance at participating providers

Up to $45

Lenses Single Vision Lenses Bifocal Vision Lenses Trifocal Vision Lenses

$25 $25 $25

Up to $40 Up to $60 Up to $80

Contact Lenses Formulary Contact Lenses (Includes up to 4 boxes of contacts, fitting/ evaluation, and 2 follow-up visits) Non-Formulary Contact Lenses Necessary Contact Lenses Semi-Monthly Contributions Employee Only Employee + Spouse/Domestic Partner Employee + Child(ren) Employee + Family

$25

Up to $200

$200 $25

Up to $200 Up to $210

$2.62 $4.96 $5.82 $8.18

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