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NVA Member Mobile App Vision Benefits on the Go

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Eligibility	Full and part-time benefit-eligible faculty, staff and retirees who meet University of Delaware age and service requirements Plan Year is the period July 1 through June 30.
Plan Administrator	National Vision Administrators (NVA) (Sponsor # 51942000001)
Who Can Use this Benefit	Employee, spouse, eligible dependent child(ren)
Benefit	Service	Frequency*	Benefits In-Network	Benefits Out-of-Network
	Comprehensive Eye Exam	Once every plan year	Covered after $15 co-pay	Up to $50
	Standard Lenses	Once every plan year	Covered in full	Single Vision up to $40 Bifocal up to $60 Trifocal up to $80 Lenticular up to $100
	Frames	Once every two plan years	Up to $150 Retail** (20% discount off remaining balance over $150 allowance. Discount does not apply at Wal-Mart/Sam's Club locations.)	Up to $80
	Contact Lenses	Once every plan year in lieu of lenses/frames	Up to $120 Retail** (15% discount (conventional) or 10% discount (disposable) off remaining balance over $120. Discounts do not apply at Wal-Mart/Sam's Club locations or Contact Fill mail orders.)	Up to $120
	Medically Necessary (pre-approval from NVA required)		Covered in full	Up to $225
	Contact Lens Evaluation/Fitting (only covered if you choose contact lenses)		Covered in full	Daily Wear $20 Extended Wear $30
	*Plan Year is the period July 1 through June 30.
	**The insured is responsible for paying any charges in excess of this allowance.
Costs	Through the flexible benefits program, the University provides Flex Credit to cover the premium for full-time employees. Benefits for dependents and retirees are voluntary and available at an additional group-rate cost.
Spousal Coordination	Not applicable to this benefit
NVA Value-Added Programs	Laser refractive surgery discount program-Lasik® Over 600 provider locations nationwide; free consultation with in-network providers $800 savings at featured providers Mail order contacts lens replacement program - Contact Fill® Low prices, dependable service, brand names shipped to members’ homes In-network benefit - no claim form required Hearing discount program - Nations Hearing® 30-60% savings on brand name hearing aids/related professional services Largest accredited network - providers in all 50 states Additional pairs discount program - EYEESSENTAL® Significant savings on additional materials purchase Unlimited usage throughout the plan year at participating providers

Vision Plan Rates

Current Plan
COBRA Monthly

Vision Coverage
	Total Monthly Rate	University Share	Employee Share
Vision Plan Administered by National Vision Administrators (NVA) for Active Employees and UD Retirees*
Employee	$4.42	$4.42	$0
Employee & Spouse	$9.50	$4.42	$5.08
Employee & Child(ren)	$7.16	$4.42	$2.74
Family	$13.06	$4.42	$8.64
*University of Delaware retirees are responsible for the Total Monthly Premium. There is no University contribution toward the cost of vision coverage for retirees or their eligible family members.

Vision Coverage
	Total Monthly Rate	COBRA @ 102%
Vision Plan Administered by National Vision Administrators (NVA)
Employee	$4.42	$4.51
Employee & Spouse	$9.50	$9.69
Employee & Child(ren)	$7.16	$7.30
Family	$13.06	$13.32

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550 S. College Ave., Suite 201, Newark, DE 19713 hrhelp@udel.edu Phone 302-831-2171