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Vision Insurance

EyeMed | PPO Vision Plan

The EyeMed vision plan provides professional vision care and high quality lenses and frames through a broad network of
optical specialists. You will receive richer benefits if you utilize a network provider. If you utilize a non-network provider,
you will be responsible to pay all charges at the time of your appointment and will be required to file an itemized claim
with EyeMed Vision.

The EyeMed network includes access to independent ophthalmologists and optometrists, as well as LensCrafters ,
®
Target Optical, Sears Optical, JCPenney Optical and most Pearle Vision retail stores.

EyeMed
PPO
Network Name PPO Non-Network
VISION BENEFITS
Copay
• Examination $10 Copay N/A
• Materials N/A N/A
Examination (Every 12 Months) 100% Up to $40 Reimbursement
Lenses (Every 12 Months)
• Single Vision 100% Up to $30 Reimbursement
• Bifocal 100% Up to $50 Reimbursement
• Trifocal 100% Up to $70 Reimbursement
• Progressive Lenses $55-$175 Allowance Up to $64 Reimbursement
Lens Options
• UV Treatment $15 Copay N/A
• Tint (Solid and Gradiant) $15 Copay N/A
• Standard Plastic Scratch Coating $15 Copay N/A
• Polycarbonate (Age 19+) $40 Copay N/A
• Polycarbonate (Under Age 19) $0 Copay Up to $32 Reimbursement
• Anti-Reflective Coating $45-$85 Copay Up to $5 Reimbursement
• Photochromic/Transitions $75 Copay N/A
• Polarized 20% Discount to Retail Price N/A
• Other Add-Ons and Services 20% Discount to Retail Price N/A
Frames (Every 12 Months) $130 Allowance, Up to $91 Reimbursement
20% Discount to Balance
Contact Lenses (Every 12 Months) (in lieu of frames and lenses)
• Cosmetic / Elective $130 Allowance Up to $130 Reimbursement
• Medically Necessary 100% Up to $210 Reimbursement
Laser Vision Correction 15% Discount to Retail Price, Not Covered
5% Discount to Promotional Price

Finding a Vision Provider:
Go to www.eyemed.com or call (866) 939-3633.

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