Page 18 - Dawson 2021 New Hire Guide
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DAWSON
Finding In-Network Providers Vision
Remember to visit in-network providers to receive the We partner with EyeMed to offer you and your family
deepest level of discount on your services. members vision insurance. Visit www.eyemed.com
To ind a participating in-network vision provider in your to ind in-network providers and access to a variety of
area, go to www.eyemed.com or call 866.939.3633. online tools and programs.
In-Network Out-of-Network
Copay
Exam Covered 100% Up to $40
Materials $10 copay
Lenses
Single Covered 100% Up to $30
Bifocal after $10 copay Up to $50
Trifocal Up to $70
Lenticular Up to $70
Standard Scratch Covered 100% Up to $5
Coating
Frames
Up to $130 Up to $91
(20% discount of
remaining balance)
Contacts
Elective $100 allowance, Up to $70
15% of remaining
balance
Medically Necessary Covered 100% Up to $210
Contact Lens Fit/Follow-Up
Fit and Follow-Up— $40
Standard
Fit and Follow-Up— 10% of retail price
Premium
Frequency
Exam 12 months
Lenses 12 months
Contacts (in lieu of 12 months
glasses)
Frames 24 months
This is a high level summary of your beneit coverage. Full coverage
details are available in your summary plan description (SPD). In the event
there is a discrepancy between what is relected in this guide and what is
communicated in your SPD, the terms of your SPD will prevail.
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Finding In-Network Providers Vision
Remember to visit in-network providers to receive the We partner with EyeMed to offer you and your family
deepest level of discount on your services. members vision insurance. Visit www.eyemed.com
To ind a participating in-network vision provider in your to ind in-network providers and access to a variety of
area, go to www.eyemed.com or call 866.939.3633. online tools and programs.
In-Network Out-of-Network
Copay
Exam Covered 100% Up to $40
Materials $10 copay
Lenses
Single Covered 100% Up to $30
Bifocal after $10 copay Up to $50
Trifocal Up to $70
Lenticular Up to $70
Standard Scratch Covered 100% Up to $5
Coating
Frames
Up to $130 Up to $91
(20% discount of
remaining balance)
Contacts
Elective $100 allowance, Up to $70
15% of remaining
balance
Medically Necessary Covered 100% Up to $210
Contact Lens Fit/Follow-Up
Fit and Follow-Up— $40
Standard
Fit and Follow-Up— 10% of retail price
Premium
Frequency
Exam 12 months
Lenses 12 months
Contacts (in lieu of 12 months
glasses)
Frames 24 months
This is a high level summary of your beneit coverage. Full coverage
details are available in your summary plan description (SPD). In the event
there is a discrepancy between what is relected in this guide and what is
communicated in your SPD, the terms of your SPD will prevail.
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