Page 9 - 2023 SpecialtyCare Puerto Rico Benefit Guide
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2023 Benefits Guide
Vision Coverage-EyeMed
Your vision plan is available through EyeMed. It provides coverage for routine eye exams and pays for all or a
portion of the cost of glasses or contact lenses if needed.
More information and a list of providers are available at www.eyemedvisioncare.com.
Benefit In-Network Out-Of-Network
Exam $10 copay Up to $35
Frequency
◼ Exam 12 months 12 months
◼ Lenses 12 months 12 months
◼ Frames 24 months 24 months
Frames Up to $140, then 20% discount Up to $70
Lenses
◼ Single Vision Lenses Up to $25
◼ Bifocal Lenses 100%, after $25 copay 100%, after Up to $40
$25 copay 100%, after $25 copay
◼ Trifocal Lenses Up to $65
Medically Necessary Contact Lenses Covered 100% Up to $200
Elective Contact Lenses in lieu of glasses Up to $140 then 15% discount Up to $112
SpecialtyCare uses the Select Network.
Remember: You can save money by staying In-Network
Eye360
Visit a PLUS provider and receive a $0 co-pay vision exam and an additional
$50 frame allowance.
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