Page 6 - AONNH19
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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.eyemedvisioncare.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 Benefit Frequency: Once Every 12 Months
allowing your doctor to Single Vision Lenses $15 copay Up to $25
compare images year over year, (pair)
and identify any changes Bifocal Lenses (pair) $15 copay Up to $40
X Retinal images also enable you Trifocal Lenses (pair) $15 copay Up to $60
to see what the doctor sees Lenticular Lenses (pair) $15 copay Up to $60
when looking inside the eye Frame Benefit Frequency: Once Every 24 Months
$130 allowance
X You’ll be able to review images Frame 20% off amount over Up to $65
with your doctor and better allowance
understand your eye health Contact Lenses (in lieu
X Retinal imaging is also referred of frame and spectacle Frequency: Once Every 12 Months
lenses)
to as fundus photography Medically Necessary (in No copay Up to $200
X Each member pays no more lieu of eyeglasses)
Conventional: $130
than $39 and is eligible for one Elective Contact Lenses allowance plus 15% off Up to $104
imaging per year balance
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 $5 .22 $11 .32
Spouse/DP
Employee and $5 .50 $11 .92
Child(ren)
Family Coverage $8 .09 $17 .52
6 2019 Benefits Enrollment
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.eyemedvisioncare.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 Benefit Frequency: Once Every 12 Months
allowing your doctor to Single Vision Lenses $15 copay Up to $25
compare images year over year, (pair)
and identify any changes Bifocal Lenses (pair) $15 copay Up to $40
X Retinal images also enable you Trifocal Lenses (pair) $15 copay Up to $60
to see what the doctor sees Lenticular Lenses (pair) $15 copay Up to $60
when looking inside the eye Frame Benefit Frequency: Once Every 24 Months
$130 allowance
X You’ll be able to review images Frame 20% off amount over Up to $65
with your doctor and better allowance
understand your eye health Contact Lenses (in lieu
X Retinal imaging is also referred of frame and spectacle Frequency: Once Every 12 Months
lenses)
to as fundus photography Medically Necessary (in No copay Up to $200
X Each member pays no more lieu of eyeglasses)
Conventional: $130
than $39 and is eligible for one Elective Contact Lenses allowance plus 15% off Up to $104
imaging per year balance
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 $5 .22 $11 .32
Spouse/DP
Employee and $5 .50 $11 .92
Child(ren)
Family Coverage $8 .09 $17 .52
6 2019 Benefits Enrollment
