Spectera Vision Plan

Available to retirees and spouses of any age.

	In Network Provider	Out of Network Provider
Vision Care Services
Exam once every 12 months	You Pay $10 Co-pay	Plan Pays $40
Frames once every 24 months	Plan Pays100% up to $130 retail	Plan Pays $45
Lenses once every 12 months
Standard Single Vision	You Pay $10 Co-pay	Plan Pays $40
Standard Bifocal	You Pay $10 Co-pay	Plan Pays $60
Standard Trifocal	You Pay $10 Co-pay	Plan Pays $80
Contact Lenses
Standard
(includes disposable/frequent wear)	You Pay $10 Co-pay	Plan Pays $125
Premium	Plan Pays 100%	Plan Pays $125
(includes toric, multifocal)	up to $125
ONE YEAR ENROLLMENT IS REQUIRED

Monthly premiums for the Spectera plan:

Single......................... $7.50
Retiree +1................ $13.25
Family ...................... $21.70


» To learn more, click here for the Spectera Brochure
» Click here for the Enrollment Form
» Click here for providers in your area


Coverage will become effective the first of the month following Doyle Rowe LTD's receipt of your completed application.

Doyle Rowe LTD enrollment hotline: 1-800-564-7227

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