Page 10 - ABM 2021 Benefit Guide DV

VISION BENEFITS

ABM has partnered with EyeMed to provide
vision coverage. Vision beneits are available
on a voluntary basis for team members and
their dependents. EyeMed ofers a network
of more than 58,000 providers at over 20,000
locations, including retail chains such as Target,
LensCrafters, and Pearle Vision. To ind a
vision provider in the EyeMed Insight Network,
use the EyeMed link on Beneitfocus or visit
eyemedvisioncare.com/locator/.

A highlight of the plan is shown in the following
table.

Out-of-
In-Network Network
Copay
Exam $10 copay $50
Contact Lens Fit and $10 copay, paid in full it $40
Follow Standard and follow up visits
Contact Lens Fit and $10 copay, 10% of retail, $40
Follow Premium then $55 allowance
Materials $20 copay
Lenses
Single $20 copay $50
Bifocal $20 copay $75
Trifocal $20 copay $100
Lenticular $20 copay $125
Frames $0 copay, $200 $100
allowance, 20% of
balance
Contacts
Conventional $0 copay, $150 $120
allowance, 15% of
balance
Disposable $0 copay, $150 $120
allowance, plus balance
Medically Necessary $0 copay, covered in full $210
Frequency
Exam 12 months
Lenses 12 months
Contacts (in lieu of 12 months
glasses)
Frames 12 months
Notes Beneits are calendar year

10 2021 Benefits Enrollment