Page 10 - Playmakers 2020 Renewal Benefits Booklet
P. 10
Playmakers, Inc. Vision Analysis
Effective November 2020
Current Renewal
EyeMed 12/12/12 EyeMed 12/12/12
Rates Counts
Employee 15 $6.88 $6.88
Employee + 1 1 $13.07 $13.07
Employee + 2 4 $19.19 $19.19
Estimated Monthly Premium $193.03 $193.03
Monthly Dollar Change $193.03
In-Network In-Network
Frequency 12/12/12 12/12/12
Eye Exam $10 $10
Materials/Eyewear $0**/$25 $0**/$25
Allowance $150 $150
This is a summary analysis only. Refer to certificate of coverage for all specific details.
This summary is not a contract and makes no representations or warranties as to final outcomes of claim adjudication.
Rate guarantee from 11/1/2020-10/31/2024.
** EyeMed: $0 Copay on Frames and Contact Lenses-$150 Allowance for each, $25 copay on Lenses if not buying contacts.
