Page 30 - ITDR Benefits & Resources guide 2019

VISION PLAN
Vision Plan Coverage
EyeMed
Your ITDR Trust plan offers Vision Coverage through EyeMed and allows for use of in-network as well as out-of-network providers. You will receive a more cost effective outcome for exams, frames and eyeglasses with an in-network provider.
To find a vision doctor in the EyeMed network visit www. EyeMed.com or call 1-866-800-5457 to speak with a customer service representative.
For LASIK providers, call 1-877-5LASER6.
BENEFITS
IN-NETWORK
OUT-OF-NETWORK
Vision Exam (once every 12 months)
with dilation as necessary
Covered in full after $10 copay
Up to $42
Lenses (once every 12 months)
Single Vision Bifocal Trifocal Lenticular
Covered in full after $10 copay Covered in full after $10 copay Covered in full after $10 copay Covered in full after $10 copay
Up to $32 Up to $46 Up to $61 Up to $61
Frames (once every 24 months)
Any available frame at provider location
$0 copay, covered up to $140; 20% off balance over $140
Up to $75
Contact Lens Fitting (once every 12 months)*
Standard Specialty
Covered in full after $25 copay Covered up to $55 after $25 copay
Up to $42 Up to $42
Contact Lenses (once every 12 months)*
Conventional Disposable Medically Necessary
Up to $130 Up to $130 Paid in Full
Up to $100 Up to $100 Up to $210
Vision Correction Procedures
LASIK - Call EyeMed for full details
15% discount
No benefit
30
* Contacts (in lieu of lenses); Lenses (in lieu of contact lenses)