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2017 BENEFITS ENROLLMENT
Vision Plan
No changes to the Monthly Vision Premiums and Plan Design for 2017
How the Plan Works In addition, you can receive extra discounts, including the following.
If you use an EyeMed provider, Paying no more than $55 for a contact lens itting and evaluation
the plan pays for an eye exam 15 percent off the regular price of laser vision correction or 5 percent
every 12 months, after you make off the promotional price from contracted facilities
a $15 copayment. You also receive
a set allowance for frames every 40 percent off a second, third, and fourth complete pair of
24 months and a set allowance eyeglass purchases once the funded beneit has been used (includes
for contact lenses every 12 prescription sunglasses)
months. The plan pays for lenses For more information about your vision beneits and to see a complete
for prescription glasses every list of member providers, visit www.eyemed.com.
12 months, after you pay a $25
copayment. Vision Benefits Plan Design
Vision Premiums In-Network Out-of-Network Frequency
Eligibility Monthly Bi-weekly You are Once every
Options Rate Rate Eye exams $15 reimbursed plan year
up to $35
Individual $5.10 $2.35 Prescription Glasses
Individual $9.69 $4.47 Lenses
+ spouse You are
Individual $10.20 $4.71 Single $25 reimbursed
+ child(ren) up to $25
You are
Individual $15.00 $6.92 Bifocal $25 reimbursed Once every
+ family up to $40 plan year
You are
Trifocal $25 reimbursed
up to $60
Polycarbonate $40 N/A
You receive a $150
allowance for frames, Once every
Frames plus a 20% discount off You are two plan
any amount over your reimbursed years
up to $75
allowance
Contact You receive a $125 Once every
allowance, 15% off
lenses— balance over $125 plan year
conventional (materials only) reimbursed
You are
Contact You receive a $125 Up to $100 Once every
allowance, plus
lenses— balance over $125 plan year
disposable (materials only)
12 Thompson Coburn LLP
Vision Plan
No changes to the Monthly Vision Premiums and Plan Design for 2017
How the Plan Works In addition, you can receive extra discounts, including the following.
If you use an EyeMed provider, Paying no more than $55 for a contact lens itting and evaluation
the plan pays for an eye exam 15 percent off the regular price of laser vision correction or 5 percent
every 12 months, after you make off the promotional price from contracted facilities
a $15 copayment. You also receive
a set allowance for frames every 40 percent off a second, third, and fourth complete pair of
24 months and a set allowance eyeglass purchases once the funded beneit has been used (includes
for contact lenses every 12 prescription sunglasses)
months. The plan pays for lenses For more information about your vision beneits and to see a complete
for prescription glasses every list of member providers, visit www.eyemed.com.
12 months, after you pay a $25
copayment. Vision Benefits Plan Design
Vision Premiums In-Network Out-of-Network Frequency
Eligibility Monthly Bi-weekly You are Once every
Options Rate Rate Eye exams $15 reimbursed plan year
up to $35
Individual $5.10 $2.35 Prescription Glasses
Individual $9.69 $4.47 Lenses
+ spouse You are
Individual $10.20 $4.71 Single $25 reimbursed
+ child(ren) up to $25
You are
Individual $15.00 $6.92 Bifocal $25 reimbursed Once every
+ family up to $40 plan year
You are
Trifocal $25 reimbursed
up to $60
Polycarbonate $40 N/A
You receive a $150
allowance for frames, Once every
Frames plus a 20% discount off You are two plan
any amount over your reimbursed years
up to $75
allowance
Contact You receive a $125 Once every
allowance, 15% off
lenses— balance over $125 plan year
conventional (materials only) reimbursed
You are
Contact You receive a $125 Up to $100 Once every
allowance, plus
lenses— balance over $125 plan year
disposable (materials only)
12 Thompson Coburn LLP
