Page 12 - 2020 Thompson Coburn Benefits Guide
P. 12
VISION PLAN
How the Plan Works
If you use an EyeMed provider, the plan pays for an eye exam every 12
months, after you make a $15 copayment. You also receive a set allowance
for frames every 24 months and a set allowance for contact lenses every
12 months. The plan pays for lenses for prescription glasses every 12
months, after you pay a $25 copayment.
In addition, you can receive extra discounts, including the following.
Paying no more than $55 for a contact lens itting and evaluation
15% off the regular price of laser vision correction or 5% off the
promotional price from contracted facilities
40% off a second, third, and fourth complete pair of eyeglass
purchases once the funded beneit has been used (includes
prescription sunglasses)
For more information about your vision beneits and to see a complete
list of member providers, visit www.eyemed.com.
Vision Benefits Plan Design
In-Network Out-of-Network Frequency
Eye exams $15 copay You are reimbursed Once every
up to $35 plan year
Prescription Glasses
Lenses
Single $25 copay You are reimbursed Once every
up to $25 plan year
Vision Premiums Bifocal $25 copay You are reimbursed
Eligibility Per Pay Monthly up to $40
Options Period Rate Trifocal $25 copay You are reimbursed
up to $60
Individual $2.63 $5.25 Polycarbonate $40 copay N/A
Individual + $4.99 $9.98 Frames You receive a $150 You are reimbursed Once every
spouse allowance for frames, plus up to $75 two plan
Individual + $5.26 $10.51 a 20% discount of any years
child(ren) amount over your allowance
Individual + $7.73 $15.45 Contact lenses— You receive a $125 You are reimbursed Once every
family conventional allowance, 15% of balance Up to $100 plan year
over $125 (materials only)
Contact lenses— You receive a $125 Once every
disposable allowance, plus balance over plan year
$125 (materials only)
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How the Plan Works
If you use an EyeMed provider, the plan pays for an eye exam every 12
months, after you make a $15 copayment. You also receive a set allowance
for frames every 24 months and a set allowance for contact lenses every
12 months. The plan pays for lenses for prescription glasses every 12
months, after you pay a $25 copayment.
In addition, you can receive extra discounts, including the following.
Paying no more than $55 for a contact lens itting and evaluation
15% off the regular price of laser vision correction or 5% off the
promotional price from contracted facilities
40% off a second, third, and fourth complete pair of eyeglass
purchases once the funded beneit has been used (includes
prescription sunglasses)
For more information about your vision beneits and to see a complete
list of member providers, visit www.eyemed.com.
Vision Benefits Plan Design
In-Network Out-of-Network Frequency
Eye exams $15 copay You are reimbursed Once every
up to $35 plan year
Prescription Glasses
Lenses
Single $25 copay You are reimbursed Once every
up to $25 plan year
Vision Premiums Bifocal $25 copay You are reimbursed
Eligibility Per Pay Monthly up to $40
Options Period Rate Trifocal $25 copay You are reimbursed
up to $60
Individual $2.63 $5.25 Polycarbonate $40 copay N/A
Individual + $4.99 $9.98 Frames You receive a $150 You are reimbursed Once every
spouse allowance for frames, plus up to $75 two plan
Individual + $5.26 $10.51 a 20% discount of any years
child(ren) amount over your allowance
Individual + $7.73 $15.45 Contact lenses— You receive a $125 You are reimbursed Once every
family conventional allowance, 15% of balance Up to $100 plan year
over $125 (materials only)
Contact lenses— You receive a $125 Once every
disposable allowance, plus balance over plan year
$125 (materials only)
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