RCA Benefit Guide
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Aetna Vision<br />
The Aetna Vision Preferred plan is a voluntary program with comprehensive coverage at a nationwide network of providers. You can<br />
use your lens coverage once every rolling 12 months to purchase either 1 pair of glasses or 1 pair of contact lenses.<br />
HEALTHY EYES WITHOUT THE HASSLE<br />
You’re covered for one routine eye exam, lenses, contacts and<br />
frames, including luxury brands.*<br />
Plus, you get:<br />
• Freedom to see any provider<br />
• Choice of popular retailers like LensCrafters, Pearle Vision,<br />
JCPenny Optical, Sears Optical, Target Optical and more<br />
• Savings on LASIK surgery, extra pairs of glasses, sunglasses<br />
and more<br />
• Night, weekend and walk-in appointments<br />
You can also buy eyewear at glasses.com,<br />
lenscrafterscontacts.com or contactsdirect.com.<br />
KEEP YOUR WELCOME MAILING HANDY<br />
It’s your ticket to an easy experience. It includes:<br />
• Your member ID card<br />
• Basic plan details<br />
• A list of local providers<br />
Bonus: A $20 LensCrafters coupon, too<br />
In-Network<br />
Out-of-Network<br />
Exam Member pays Reimbursement<br />
Routine/Comprehensive Eye Exam $10 copay Up to $25<br />
Standard Contact Lens Fit/Follow-up Discounted fee of $40 Not covered<br />
Premium Contact Lens Fit/Follow-up 90% of retail Not covered<br />
Eyeglass Lenses / Lens Options<br />
Standard Plastic Single Vision Lenses $25 copay Up to $10<br />
Standard Plastic Bifocal Vision Lenses $25 copay Up to $25<br />
Standard Plastic Trifocal Vision Lenses $25 copay Up to 55<br />
Standard Plastic Lenticular Vision Lenses $25 copay Up to $55<br />
Standard Progressive Vision Lenses $90 copay Up to $25<br />
Premium Progressive Vision Lenses 20% discount off retail minus $120 Up to $25<br />
Lens Enhancements Discounted fees Not covered<br />
Contact Lenses<br />
Conventional Contact Lenses $130 allowance, plus 15% off Up to $90<br />
Disposable Contact Lenses $130 allowance Up to $90<br />
Medically Necessary Contact Lenses $0 copay Up to $200<br />
Frames (every 24 months)<br />
Any frame, including frames for<br />
$130 allowance, plus 20% off<br />
prescription sunglasses<br />
balance over allowance<br />
Up to $65<br />
2018 Recovery Centers of America <strong>Benefit</strong> <strong>Guide</strong> | 9