Page 10 - 2022 MLB Benefit Guide 08.2022

Vision – EyeMed

Your vision program, insured by EyeMed, also offers you two options for coverage, network and non-network care.
This plan provides each covered family member with coverage for eye exams and necessary corrective lenses,
including eyeglasses or contact lenses.

EyeMed has a large network of member
providers. If you choose to use one of those
providers, you will pay substantially less
than if you go to a provider outside the
EyeMed network. To locate an EyeMed
participating provider in your community,
call 1-866-939-3633 or visit the EyeMed
website at www.eyemedvisioncare.com and
click on Find a Provider.

Refer to the EyeMed materials in the
appendix for information on plan benefits
and processing out-of-network claims. All
out-of-network vision claims must be
submitted within six months of the date of
service.

Vision Plan Benefits Summary

Service In-Network Out-of-Network Reimbursement
Annual Eye Exam $10 Copay Up $50 (copay applies)
Exam: Once Every Calendar Year
Frequency Lenses: Once Every Calendar Year
Frames: Once Every Other Calendar Year
Eyeglass Lenses
Single $25 Copay Up to $50 (copay applies)
Bifocal Up to $75 (copay applies)
Trifocal Up to $100 (copay applies)
$25 Copay, $130 Retail
Eyeglass Frames Allowance, 20% discount on Up to $70 (copay applies)
charges over $120
Medically Necessary Contact Paid in full Up to $210
Lenses
Elective Contact Lenses in lieu
of Glasses $120 Allowance Up to $105
Tints, Special Coatings, etc. on Additional Charge, Discounted at N/A
Lenses Network Doctors

Click here for a detailed Vision Plan Summary

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