Page 16 - TCW_Benefit Guide_2019 FINAL

VISION COVERAGE

EYEMED SELECT VISION SUMMARY
Vision coverage is available to encourage you and your family to maintain healthy eyesight
and provides benefits for eye exams, prescription eyeglasses and contact lenses. Vision
benefits are through EyeMed and TCW pays 100% of the premium cost for employees and
most of the cost for dependent coverage. Visit www.eyemed.com to find an EyeMed network
provider near you.

Here is a brief summary of key features:

EYEMED VISION
PLAN SUMMARY IN-NETWORK OUT-OF-NETWORK REIMBURSEMENT
Vision Exam $10 copay Up to $35
Retinal Imaging Benefits Up to $39 N/A
Frequency
Exam Once Every 12 Months Once Every 12 Months
Lenses or Contact Lenses Once Every 12 Months Once Every 12 Months
Frame Once Every 12 Months Once Every 12 Months
Frames
$0 copay; $120 Allowance, Up to $60
20% off balance over $120
Standard Plastic Lens
Single Vision $25 copay Up to $35
Bifocal $25 copay Up to $49
Trifocal $25 copay Up to $74
$25 copay,
Standard Progressive Lens Up to $49
80% of Charge less $120 Allowance
Lens Options
UV Treatment $15 N/A
Standard Plastic scratch coating $15 N/A
Standard Anti-Reflective coating $45 N/A
Contacts (instead of glasses)
$135 Allowance
Up to $108
Contact Lenses ($0 copay and paid in full if medically (up to $210 if medically necessary)
necessary)
15% off Retail Price or
Laser Vision Correction N/A
5% promotional price
The above information is provided for illustrative purposes only. Refer to the applicable carrier material for exact description of plan
benefits and conditions.
AMPLIFON HEARING HEALTH CARE
Hearing and vision loss can go hand in hand. EyeMed wants you to enjoy all life’s sights – and
sounds – to the fullest. Members have access to affordable hearing care discounts through
Amplifon, the world’s largest distributor of hearing aids and services.

Members receive a 40% discount off hearing exams and a low price guarantee on
discounted hearing aids.

YOUR VISION CONTRIBUTIONS

PLAN TYPE COVERAGE TIER EMPLOYEE SEMI-MONTHLY RATE
VISION
Employee $0.00
EyeMed Vision Employee + 1 $1.00
14 Employee + Family $2.00