Page 13 - 2020FCSBenefitsGuide
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Vision
The group vision plan is offered through EyeMed. The plan offers a Retinal Imaging
comprehensive package of vision beneits designed to promote proper X The high-resolution images
eye health. For a complete listing of network providers, please visit of the inside of your eye
www.eyemed.com. can help your doctor identify
the early signs of common
In-Network Out-of-Network
Vision Exam Frequency: Once Every 12 Months eye conditions
Routine Eye Exam $10 copay Up to $30 X They also provide a historical
Lens Beneit Frequency: Once Every 12 Months baseline of your eye health,
Single Vision Lenses (pair) $15 copay Up to $25 allowing your doctor to
Bifocal Lenses (pair) $15 copay Up to $40 compare images year-over-year,
Trifocal Lenses (pair) $15 copay Up to $60 and identify any changes
Lenticular Lenses (pair) $15 copay Up to $60 X Retinal images also enable you
Frame Beneit Frequency: Once Every 24 Months to see what the doctor sees
Frame $130 allowance Up to $65
20% of amount over when looking inside the eye
allowance
Contact Lenses (In Lieu of Frame Frequency: Once Every 12 Months X You’ll be able to review images
and Spectacle Lenses) with your doctor and better
Medically Necessary (in lieu of No copay Up to $200 understand your eye health
eyeglasses)
Elective Contact Lenses Conventional: $130 Up to $104 X Retinal imaging is also referred
allowance plus 15% of to as fundus photography
balance
Disposable: $130 X Each member pays no more
allowance than $39 and is eligible for one
To research vision providers please look for the following network: www.eyemed.com imaging per year
For additional information visit the FCS intranet.
Vision Payroll Deductions
Vision Plan—Bi-Weekly Vision Plan—Monthly
Deductions Deductions
Employee Only $2.75 $5.96
Employee and Spouse/DP $5.22 $11.32
Employee and Child(ren) $5.50 $11.92
Family Coverage $8.09 $17.52
Florida Cancer Specialists and Research Institute 13
The group vision plan is offered through EyeMed. The plan offers a Retinal Imaging
comprehensive package of vision beneits designed to promote proper X The high-resolution images
eye health. For a complete listing of network providers, please visit of the inside of your eye
www.eyemed.com. can help your doctor identify
the early signs of common
In-Network Out-of-Network
Vision Exam Frequency: Once Every 12 Months eye conditions
Routine Eye Exam $10 copay Up to $30 X They also provide a historical
Lens Beneit Frequency: Once Every 12 Months baseline of your eye health,
Single Vision Lenses (pair) $15 copay Up to $25 allowing your doctor to
Bifocal Lenses (pair) $15 copay Up to $40 compare images year-over-year,
Trifocal Lenses (pair) $15 copay Up to $60 and identify any changes
Lenticular Lenses (pair) $15 copay Up to $60 X Retinal images also enable you
Frame Beneit Frequency: Once Every 24 Months to see what the doctor sees
Frame $130 allowance Up to $65
20% of amount over when looking inside the eye
allowance
Contact Lenses (In Lieu of Frame Frequency: Once Every 12 Months X You’ll be able to review images
and Spectacle Lenses) with your doctor and better
Medically Necessary (in lieu of No copay Up to $200 understand your eye health
eyeglasses)
Elective Contact Lenses Conventional: $130 Up to $104 X Retinal imaging is also referred
allowance plus 15% of to as fundus photography
balance
Disposable: $130 X Each member pays no more
allowance than $39 and is eligible for one
To research vision providers please look for the following network: www.eyemed.com imaging per year
For additional information visit the FCS intranet.
Vision Payroll Deductions
Vision Plan—Bi-Weekly Vision Plan—Monthly
Deductions Deductions
Employee Only $2.75 $5.96
Employee and Spouse/DP $5.22 $11.32
Employee and Child(ren) $5.50 $11.92
Family Coverage $8.09 $17.52
Florida Cancer Specialists and Research Institute 13
