Vision Benefits At-A-Glance

Monthly Premiums

The Advantica Eyecare Vision Plan helps pay for eye exams, eyeglasses (lenses and frames) and contact lenses. This plan uses the Advantica Eyecare Vision network, but you have the flexibility to receive care from any optometrist or optician you prefer. If you choose an out-of-network provider, your reimbursement rate of eligible expenses will be lower. You can enroll in vision coverage whether or not you have medical or dental coverage through St. Jude. If you choose vision coverage, you will need to select from one of two coverage tiers (Employee Only or Family).

Vision Benefits At-A-Glance

Benefit	Frequency	In-Network	Out-of-Network
Exam	One time every 12 months	$10 copay	Plan pays $30 toward exams, less $10 copay
Frames and lenses1 or contact lenses2		$10 copay ($150 maximum)	Plan pays $80 toward purchases of eyeglasses, less $10 copay
LASIK Surgery3	One-time (lifetime benefit)	15% discount on R&C4	No benefit
1Benefit for eyeglasses includes frames and lenses (i.e., single vision, bifocal and trifocal): $150 maximum. 2Contacts in lieu of frames and lenses: $150 allowance to be applied toward the contact lenses. 3Call Tru-Vision at 1-866-486-2020 for details about the LASIK benefit. You can set aside money in a health care Flexible Spending Account to pay for your portion of the surgery—tax free. 4R&C is reasonable and customary rates prevailing in the geographic area in which the expenses are incurred.

 

In-Network providers include EyeMasters, Sears, J.C. Penney, Pearle Vision, For Eyes Optical, 2001 Vision Center, Eyecare Center of Memphis, Cole Vision Corp, Factory Outlet and Target Optical. For more information, go to www.advanticaeyecare.com.

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Monthly Premiums

You contribute the full amount for vision coverage on a pre-tax basis. You receive a group rate, which is likely to be lower than plans you could purchase on an individual basis. The table below shows your monthly contributions if you choose coverage under the plan.

2013 Benefits	Your Monthly Premium1		Monthly COBRA Rates2
Vision	Full-time	Part-time
Employee only	$7	$7	$7
Family	$14	$14	$14
1Same Gender Domestic Partner—Family (incl. SGP) Tier (Full-time/Part-time/COBRA): $14 / $14 / $14 2This is the full cost of coverage if you or one of your dependents loses coverage under the plan and becomes eligible for COBRA.

 

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