Page 13 - Think Goodness Enrollment 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 one vision plan through EyeMed.

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

Exam $10 copay Up to $40 off

$130 allowance
Frames Up to $91 off
plus 20% off balance over $130
Lenses
 Single Vision Lenses $10 copay Up to $30 to $70, depending on lens type
 Bifocal Lenses $10 copay Up to $30 to $70, depending on lens type
 Trifocal Lenses $10 copay Up to $30 to $70, depending on lens type
Contact Lenses
 Elective $40 copay + $130 allowance Up to $105 off
Frequency
 Exam Every 12 months Every 12 months
 Lenses Every 12 months Every 12 months
 Frames Every 24 months Every 24 months
 Contact Lenses Every 12 months Every 12 months

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