Solstice — Clear 10 Pre-Paid Vision Plan

MORE INFORMATION ON YOUR DENTAL & VISION

Oral Health Impactsyour Overall Health

in-network procedures	member co-payments	exclusions and limitations
Eye Exam	$4	One exam every 12 months
Single Lenses	$10	One standard pair
Bifocal Lenes	$10	Plastic or Clear glasses
Trifocal Lenes	$10	Every 12 months
Lens options*	20% discount	None
Frames	$79 retail allowance after $10 co-payment	Frames every 12 months OR
Contact Lenses	$85 allowance**	Contact lenses every 12 months
Medically Necessary Contact Lenses	PAID IN FULL	Plastic or Clear glasses

Important Note: This program is not insurance
*Lens options:tint, UV, anti-scratch coat, anti-reflective, progressive, polycarbonate, hi-index, photogray,
transitions, poloroid.
**Allowance is for exam, fitting, evaluation, follow-up care and materials.

	Monthly Deductions	20 Bi-weekly deductions	24 bi-weekly deductions	26 bi-weekly deductions
Employee	$3.10	$1.86	$1.55	$1.43
Employee & Dependent	$5.60	$3.36	$2.80	$2.58
Employee & Family	$9.66	$5.80	$4.83	$4.46

No waiting periods

no deductibles

no claim forms to submit

member co-payments listed are guaranteed to be a 20% - 45% discount and are offered by a participating Solstice provider.