Page 12 - Oremor EE Benefits Guide 01-19.pub
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Benefits
Vision Insurance
PPO Vision Plan | EyeMed
The EyeMed vision plan provides professional vision care and high quality lenses and frames through a broad network of op cal
specialists. You will receive richer benefits if you u lize a network provider. If you u lize a non‐network provider, you will be
responsible to pay all charges at the me of your appointment and will be required to file an itemized claim with EyeMed.
EyeMed Note
Plan Name PPO Plan The EyeMed
Network Name Network Non‐Network network includes
access to
Copay independent
‐ Examina on $10 Copay N/A ophthalmologists
‐ Materials $10 Copay N/A and optometrists, as
Examina on 100% $42 Reimbursement well as
LensCra ers®,
Lenses Target Op cal, Sears
‐ Single Vision 100% $35 Reimbursement Op cal, JCPenney
‐ Bifocal 100% $49 Reimbursement Op cal and most
‐ Trifocal 100% $74 Reimbursement Pearle Vision retail
stores.
Frames $130 Benefit $65 Reimbursement
Contact Lenses In Lieu of Frames and Lenses
‐ Cosme c / Elec ve $105 Benefit $84 Reimbursement
‐ Medically Necessary 100% $210 Reimbursement
Laser Vision Correc on Discounts Apply Not Covered
Frequency
‐ Examina on 12 Months
‐ Lenses 12 Months
‐ Frames 12 Months
‐ Contact Lenses 12 Months
Finding a Vision Provider
Go to www.eyemedvisioncare.com or call (866) 723‐0513. Refer to the “Access” network when prompted.
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