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ADDITIONAL DISCOUNTS EXCLUSIONS & LIMITATIONS
Member will receive a 20% discount on • Orthoptic or vision training, subnormal vision aids, and
items not covered by the plan at network any associated supplemental testing
Providers, which may not be combined • Plano non-prescription lenses and non-prescription
with any other discounts or promotional sunglasses (except for 20% discount)
offers, and the discount does not apply to
EyeMed Provider's professional services, • Medical and/or surgical treatment of the eye, eyes, or
or contact lenses. Retail prices may vary supporting structures
by location. • Services or materials provided by any other group benefit
providing for vision care
Discounts do not apply for benefits provided
by other group benefit plans. Allowances are • Services provided as a result of any Workers'
one-time use benefits; no remaining balance. Compensation law
• Two pair of glasses in lieu of bifocals
Lost or broken materials are not covered.
Members also receive a 40% discount off • Benefit is not available on certain frame brands in which
complete pair eyeglass purchases and a 15% the manufacturer imposes a no discount policy
discount off conventional contact lenses • Aniseikonic lenses
once the funded benefit has been used.
• Corrective eyewear required by an employer as a
Members also receive 15% off retail price or condition of employment, and safety eyewear unless
5% off promotional price for Lasik or PRK specifically covered under plan
from the US Laser Network, owned and Some provisions, benefits, exclusions or limitations listed
operated by LCA Vision.
may vary by state.
Since Lasik or PRK vision correction is an
elective procedure, performed by specially
trained providers, this discount may not
t8
always be available from a provider in your EyeMed Vision Care , is underwritten by Fidelity Security Life
immediate location. Insurance Company of Kansas City, Missouri, provided by Policy
numbers VC-77/VC-78, form number M-9083.
For a location near you and the discount This is a snapshot of your benefits. The Certificate of Insurance is on
authorization please call 1-877-5LASER6 file with your employer.
After initial purchase, replacement contact
lenses may be obtained via the Internet at For use in: AL, AK, AZ, CA, CO, CT, DC, DE, GA, HI, ID, IA,
substantial savings and mailed directly IL, IN, KS, KY, LA, MD, ME, Ml, MO, MS, MT, NC, ND, NE,
to the member. Details are available at NH, NJ, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT,
www.eyemedvisioncare.com. VA, VT, WI, WV, WY.
The contact lens benefit allowance is not
applicable to this service. EyeMed Vision Care ® is offered through an arrangement
between Fidelity Security Life Insurance Company and
Allstate Benefits, the marketing name used by American
Heritage Life Insurance Company (Home Office, Jacksonville,
FL), a subsidiary of The A I I state Corporation. ©2013 Allstate
Insurance Company. www.allstate.com or allstatebenefits.com
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