Page 13 - Gerald R Ford International Airport Authority 2022 Benefits Guide

Vision plan

The vision plan provides coverage for routine eye exams and pays for all or a portion of the cost of glasses or contact
lenses. You can choose any provider; however, you always save money if you see in-network providers. We offer a vision
plan through EyeMed.

EyeMed Vision Plan
Plan Provisions In-Network Out-of-Network

Exam $0 copay Up to $40 off
$0 copay, $130 allowance
Frames Up to $91 off
plus 20% off balance over $130
Lenses
● Single vision lenses $10 copay Up to $120 off
● Bifocal lenses $10 copay Up to $30 off
● Trifocal lenses $10 copay Up to $50 off
Contact Lenses
● Conventional $0 copay, $130 allowance, Up to $130 off
15% balance over $130
● Disposable $0 copay, $130 allowance, Up to $130 off
15% balance over $130

● Medically necessary $0 copay, paid-in-full Up to $120 off
Frequency
● Exam Once every 12 months
● Lenses Once every 12 months
● Frames Once every 24 months
● Contact lenses Once every 12 months

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