City of Pomona
Vision Insurance
(Voluntary)
Employee Monthly Premium Costs
&
Safeguard Vision Plan Benefits
Effective January 1, 2008-December 31,2008
| Employee Monthly Premium Cost |
Employee Only Employee+1 Employee+2 or more | $7.70 $12.00 $19.31 |
| Safeguard Plan Benefits |
- Freedom to choose any licensed optometrist
- Reimbursements for out-of-network use
- Out-of-network claims processed quickly
- An exam and lenses every 12 months
- Frames every 12 months
- Standard frames and lenses covered at 100%
- $10 co-payment in network for comprehensive exam
- Contact lenses in lieu of frames and glasses- $110 credit if preferred provider is used.
- In-network laser vision correction discount of 15% at participating providers
*If you request special upgrades for your frames and /or lenses, you will be responsible for the difference between the provider's usual fee and the appropriate credit as listed on your Schedule of Benefits, less a 20% discount on that amount. Safeguard Schedule of Benefits may be obtained from Human Resources.
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