Vision Plan
Keeping your vision clear and eyes in good health.
We partner with EyeMed to provide quality vision care nationwide. Although vision care services and supplies are covered in-network and out-of-network, your benefits are generally greater when you use in-network providers.
| VISION PLAN | |||||
|---|---|---|---|---|---|
| Participating Provider
You Pay |
Non-Participating
Provider Reimbursement |
||||
| COST | |||||
| Exam | $10 | Up to $35 | |||
| Contact Lens Evaluation & Fitting | $40 | N/A | |||
| COVERED SERVICES — LENSES AND FRAMES | |||||
| Single Lenses | $10 copay | Up to $25 | |||
| Bifocals | $10 copay | Up to $40 | |||
| Trifocals | $10 copay | Up to $60 | |||
| Frames | 80% of balance over $120 allowance | Up to $48 | |||
| COVERED SERVICES — CONTACTS IN LIEU OF FRAMES/LENSES | |||||
| Contacts – Medically Necessary | $0 | Up to $200 | |||
| Contacts – Elective | 85% of balance over $135 allowance | Up to $95 | |||
| BENEFIT FREQUENCY | |||||
| Exams | Once every calendar year | Once every calendar year | |||
| Lenses | Once every calendar year | Once every calendar year | |||
| Contacts | Once every calendar year | Once every calendar year | |||
| Frames | Once every other calendar year | Once every other calendar year | |||
Visit www.eyemed.com or call 866.665.8437.