Page 12 - 2018 Thompson Coburn Enrollment
P. 12
Vision Plan
How the Plan Works
If you use an EyeMed provider, In addition, you can receive extra discounts, including the following.
the plan pays for an eye exam X Paying no more than $55 for a contact lens itting and evaluation
every 12 months, after you make
a $15 copayment. You also receive X 15 percent off the regular price of laser vision correction or 5 percent
a set allowance for frames every off the promotional price from contracted facilities
24 months and a set allowance X 40 percent off a second, third, and fourth complete pair of
for contact lenses every 12 eyeglass purchases once the funded beneit has been used (includes
months. The plan pays for lenses prescription sunglasses)
for prescription glasses every
12 months, after you pay a $25 For more information about your vision beneits and to see a complete
copayment. list of member providers, visit www.eyemed.com.
Vision Premiums Vision Benefits Plan Design
Eligibility Monthly Bi-weekly
Options Rate Rate In-Network Out-of-Network Frequency
Individual $5.25 $2.42 Eye exams $15 You are reimbursed Once every
plan year
up to $35
Individual + $9.98 $4.61 Prescription Glasses
spouse Lenses
Individual + $10.51 $4.85 Single $25 You are reimbursed Once every
child(ren) up to $25 plan year
Individual + $15.45 $7.13 Bifocal $25 You are reimbursed
up to $40
family Trifocal $25 You are reimbursed
up to $60
Polycarbonate $40 N/A
Frames You receive a $150 Once every
allowance for frames, You are reimbursed two plan years
plus a 20% discount off up to $75
any amount over your
allowance
Contact lenses— You receive a $125 You are reimbursed Once every
conventional allowance, 15% off Up to $100 plan year
balance over $125
(materials only)
Contact lenses— You receive a $125 Once every
disposable allowance, plus balance plan year
over $125 (materials only)
12 2018 Benefits Enrollment
How the Plan Works
If you use an EyeMed provider, In addition, you can receive extra discounts, including the following.
the plan pays for an eye exam X Paying no more than $55 for a contact lens itting and evaluation
every 12 months, after you make
a $15 copayment. You also receive X 15 percent off the regular price of laser vision correction or 5 percent
a set allowance for frames every off the promotional price from contracted facilities
24 months and a set allowance X 40 percent off a second, third, and fourth complete pair of
for contact lenses every 12 eyeglass purchases once the funded beneit has been used (includes
months. The plan pays for lenses prescription sunglasses)
for prescription glasses every
12 months, after you pay a $25 For more information about your vision beneits and to see a complete
copayment. list of member providers, visit www.eyemed.com.
Vision Premiums Vision Benefits Plan Design
Eligibility Monthly Bi-weekly
Options Rate Rate In-Network Out-of-Network Frequency
Individual $5.25 $2.42 Eye exams $15 You are reimbursed Once every
plan year
up to $35
Individual + $9.98 $4.61 Prescription Glasses
spouse Lenses
Individual + $10.51 $4.85 Single $25 You are reimbursed Once every
child(ren) up to $25 plan year
Individual + $15.45 $7.13 Bifocal $25 You are reimbursed
up to $40
family Trifocal $25 You are reimbursed
up to $60
Polycarbonate $40 N/A
Frames You receive a $150 Once every
allowance for frames, You are reimbursed two plan years
plus a 20% discount off up to $75
any amount over your
allowance
Contact lenses— You receive a $125 You are reimbursed Once every
conventional allowance, 15% off Up to $100 plan year
balance over $125
(materials only)
Contact lenses— You receive a $125 Once every
disposable allowance, plus balance plan year
over $125 (materials only)
12 2018 Benefits Enrollment
