Page 15 - Enrollment Guide
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Vision
Vision
Our vision coverage is offered through EyeMed Vision Care. Vision
coverage is a voluntary beneit. Your cost for this coverage is entirely
separate from our medical and dental beneit programs. A highlight of the
plan is shown in the following table.
Vision Plan Description In-Network Out-of-Network
Copay
Exam $15 copay Up to $30
Materials $15 copay Varies
Lenses
Single $15 copay Up to $25
Bifocal $15 copay Up to $40
Trifocal $15 copay Up to $60
Frames $120 allowance Up to $60
Contacts
Medically necessary 100% no copay Up to $200
Elective $150 allowance Up to $120
Frequency
Exam 12 months 12 months
Lenses 12 months 12 months
Contacts (in lieu of glasses) 12 months 12 months
Frames 12 months 12 months
Your 2016 monthly contributions for vision coverage are shown below.
Eyemed PPO Plan
Employee $2.87
Employee + spouse $5.45
Employee + child(ren) $5.73
Family $8.43
Benefit Guide 2016
Vision
Vision
Our vision coverage is offered through EyeMed Vision Care. Vision
coverage is a voluntary beneit. Your cost for this coverage is entirely
separate from our medical and dental beneit programs. A highlight of the
plan is shown in the following table.
Vision Plan Description In-Network Out-of-Network
Copay
Exam $15 copay Up to $30
Materials $15 copay Varies
Lenses
Single $15 copay Up to $25
Bifocal $15 copay Up to $40
Trifocal $15 copay Up to $60
Frames $120 allowance Up to $60
Contacts
Medically necessary 100% no copay Up to $200
Elective $150 allowance Up to $120
Frequency
Exam 12 months 12 months
Lenses 12 months 12 months
Contacts (in lieu of glasses) 12 months 12 months
Frames 12 months 12 months
Your 2016 monthly contributions for vision coverage are shown below.
Eyemed PPO Plan
Employee $2.87
Employee + spouse $5.45
Employee + child(ren) $5.73
Family $8.43
Benefit Guide 2016
