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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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