Office of Group Insurance
Department of Administration

Employee Group Insurance Benefits

Vision Plan Snapshot

Your vision coverage is included in your medical coverage choice. For details about the vision plan, waiting periods, limitations, and how the plan works, please see the Benefits Summary & Plan Contracts.

Plan Feature	Benefit			Documents
	FY2012	FY2013	Limitations	Traditional	PPO	High Deductible
Eye Exam	$32	$50	one (1) exam every 12 months	Benefits Summary Plan Contract	Benefits Summary Plan Contract	Benefits Summary Plan Contract
Frame	up to $30	up to $50	one (1) frame every 24 months
Single Vision lenses, pair	up to $32	up to $50	one (1) pair every 12 months
Bifocal lenses, pair	up to $60	up to $80
Trifocal lenses, pair	up to $72	up to $95
Lenticular lenses, pair	up to $100	up to $125
Elective Contacts, pair	up to $47	up to $70
Medically-Necessary Contacts, pair	up to $100	up to $125

QUESTIONS?

Phone:
Fax:
Email:

(208) 332-1860 or (800) 531-0597
(208) 332-1888
ogi@adm.idaho.gov