Page 14 - Burke Hospital 2022 Benefits Summary
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Voluntary Vision Benefits
Administered by EyeMed
Regular eye examinations can not only determine your need for corrective eyewear, but also may detect general health problems in their earliest stages. Protection for the eyes should be a major concern to everyone, therefore regular eye exams are recommended. All benefits eligible employees may elect to enroll in the voluntary vision plan offered by EyeMed. Employees pay the full cost of this plan offered at group rates, through payroll deductions.
Eye Exam
Benefit Details
Member Cost
Out-of-Network Allowance
Standard Plastic Lenses
Single Vision
Bifocal
Trifocal
Lenticular
Frames
Any available frame at provider location
Contact Lenses (Contact lens allowance includes materials only)
Conventional
Disposable
Medically Necessary
Frequency
Examination
Lenses or Contact Lenses
Frames
$10 copay
$30
$25 $40 $60 $60
$65
$104
$104 $200
$25 copay
$25 copay
$25 copay
$25 copay
$0 copay; $130 allowance 20% off balance over $130
$0 copay; $130 allowance, 15% off balance
$0 copay; $130 allowance $0 copay, paid in full
Once every 12 months Once every 12 months Once every 12 months
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You make the Difference.
