Page 10 - 2020AONBenefitGuide
P. 10
Vision
Retinal Imaging The group vision plan is offered through EyeMed. The plan offers a
X The high-resolution images comprehensive package of vision beneits designed to promote proper
of the inside of your eye can eye health. For a complete listing of network providers, please visit
help your doctor identify the www.eyemed.com.
early signs of common eye In-Network Out-of-Network
conditions Vision Exam Frequency: Once Every 12 Months
X They also provide a historical Routine Eye Exam $10 copay Up to $30
baseline of your eye health, Lens Beneit Frequency: Once Every 12 Months
allowing your doctor to Single Vision Lenses (pair) $15 copay Up to $25
compare images year over year, Bifocal Lenses (pair) $15 copay Up to $40
and identify any changes Trifocal Lenses (pair) $15 copay Up to $60
X Retinal images also enable you Lenticular Lenses (pair) $15 copay Up to $60
to see what the doctor sees Frame Beneit Frequency: Once Every 24 Months
$130 allowance
when looking inside the eye Frame 20% of amount over Up to $65
X You’ll be able to review images allowance
with your doctor and better Contact Lenses (in lieu
understand your eye health of frame and spectacle Frequency: Once Every 12 Months
lenses)
X Retinal imaging is also referred Medically Necessary (in lieu No copay Up to $200
to as fundus photography of eyeglasses) Conventional: $130
X Each member pays no more allowance plus 15% of
than $39 and is eligible for one Elective Contact Lenses balance Up to $104
imaging per year Disposable: $130
allowance
To research vision providers, please look for the following network:
www.eyemed.com.
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
10 2020 Benefits Guide
Retinal Imaging The group vision plan is offered through EyeMed. The plan offers a
X The high-resolution images comprehensive package of vision beneits designed to promote proper
of the inside of your eye can eye health. For a complete listing of network providers, please visit
help your doctor identify the www.eyemed.com.
early signs of common eye In-Network Out-of-Network
conditions Vision Exam Frequency: Once Every 12 Months
X They also provide a historical Routine Eye Exam $10 copay Up to $30
baseline of your eye health, Lens Beneit Frequency: Once Every 12 Months
allowing your doctor to Single Vision Lenses (pair) $15 copay Up to $25
compare images year over year, Bifocal Lenses (pair) $15 copay Up to $40
and identify any changes Trifocal Lenses (pair) $15 copay Up to $60
X Retinal images also enable you Lenticular Lenses (pair) $15 copay Up to $60
to see what the doctor sees Frame Beneit Frequency: Once Every 24 Months
$130 allowance
when looking inside the eye Frame 20% of amount over Up to $65
X You’ll be able to review images allowance
with your doctor and better Contact Lenses (in lieu
understand your eye health of frame and spectacle Frequency: Once Every 12 Months
lenses)
X Retinal imaging is also referred Medically Necessary (in lieu No copay Up to $200
to as fundus photography of eyeglasses) Conventional: $130
X Each member pays no more allowance plus 15% of
than $39 and is eligible for one Elective Contact Lenses balance Up to $104
imaging per year Disposable: $130
allowance
To research vision providers, please look for the following network:
www.eyemed.com.
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
10 2020 Benefits Guide
