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Vision Care Vision beneits are essential to
maintaining your overall health and
well-being. Our vision care coverage
Out-Of-Network
In-Network “Member” Costs Reimbursement is through EyeMed, and includes
beneits for in-network and out of
Eye exam $10 copay Up to $30 network care.
Contact Lens it and follow-up You can apply your vision beneits
Standard $0 copay, plus 2 covered follow up Up to $40 toward any eye exam, any available
visits at no charge to the employee frames, or brand of contact lenses that
Premium $0 copay, 10% off retail price, then Up to $40 it your lifestyle.
apply $55 allowance
Frames How to Find a Vision
$0 copay, $130 allowance; 20% off Up to $40 Provider
balance over $130
Standard Plastic Lenses (tinting and/or coating not covered) Visit www.eyemedvisioncare.com
Single vision $25 copay Up to $15 and select the Insight Network.
Bifocal $25 copay Up to $30 Additional Online
Trifocal $25 copay Up to $45 Resources
Lenticular $25 copay Up to $45 There are a variety of tools
Standard progressive $25 copay Up to $45 available to you through
Premium progressive $45-70 copay Up to $45 www.eyemedvisioncare.com
(tier 1–3) including the features below.
Premium progressive $25 copay 80% of charge less Up to $45
(tier 4) $120 allowance Check your claims status
Contact Lenses (allowance covers materials only)
Conventional $0 copay, $130 allowance; 15% off Up to $130 Print your member ID card
balance over $130
Disposables $0 copay, $130 allowance Up to $130 Review your beneit details
Medically necessary $0 copay; paid in full Up to $210 Explore educational resources
LASIK and PRK 15% off retail price or 5% off N/A
promotional pricing You can also download the free
Frequency Limits “EyeMed Members” mobile app
®
Exam Once every twelve months through the Apple iTunes store or
Frames Once every twenty four months Google Play.
Lenses or contact Once every twelve months
lenses
Please refer to your Summary Plan Description (SPD) for complete details of plan beneits,
limitations, and exclusions. In the event of a conlict between the SPD and this description, the
terms of the SPD will prevail.
2016 New Hire Enrollment
Vision Care Vision beneits are essential to
maintaining your overall health and
well-being. Our vision care coverage
Out-Of-Network
In-Network “Member” Costs Reimbursement is through EyeMed, and includes
beneits for in-network and out of
Eye exam $10 copay Up to $30 network care.
Contact Lens it and follow-up You can apply your vision beneits
Standard $0 copay, plus 2 covered follow up Up to $40 toward any eye exam, any available
visits at no charge to the employee frames, or brand of contact lenses that
Premium $0 copay, 10% off retail price, then Up to $40 it your lifestyle.
apply $55 allowance
Frames How to Find a Vision
$0 copay, $130 allowance; 20% off Up to $40 Provider
balance over $130
Standard Plastic Lenses (tinting and/or coating not covered) Visit www.eyemedvisioncare.com
Single vision $25 copay Up to $15 and select the Insight Network.
Bifocal $25 copay Up to $30 Additional Online
Trifocal $25 copay Up to $45 Resources
Lenticular $25 copay Up to $45 There are a variety of tools
Standard progressive $25 copay Up to $45 available to you through
Premium progressive $45-70 copay Up to $45 www.eyemedvisioncare.com
(tier 1–3) including the features below.
Premium progressive $25 copay 80% of charge less Up to $45
(tier 4) $120 allowance Check your claims status
Contact Lenses (allowance covers materials only)
Conventional $0 copay, $130 allowance; 15% off Up to $130 Print your member ID card
balance over $130
Disposables $0 copay, $130 allowance Up to $130 Review your beneit details
Medically necessary $0 copay; paid in full Up to $210 Explore educational resources
LASIK and PRK 15% off retail price or 5% off N/A
promotional pricing You can also download the free
Frequency Limits “EyeMed Members” mobile app
®
Exam Once every twelve months through the Apple iTunes store or
Frames Once every twenty four months Google Play.
Lenses or contact Once every twelve months
lenses
Please refer to your Summary Plan Description (SPD) for complete details of plan beneits,
limitations, and exclusions. In the event of a conlict between the SPD and this description, the
terms of the SPD will prevail.
2016 New Hire Enrollment
