Page 15 - Ria Benefits Guide 2020 FINAL CO

VISION PLAN

EyeMed Vision Plan

EYEMED | VISION PLAN
Ria provides vision coverage through EyeMed Vision. You can see an EyeMed in-network provider or an out-of-network provider,
however, your costs will be lower if you visit an in-network provider. If you visit an in-network provider you will be responsible for a
copayment at the time of your service. If you receive services from an out-of-network doctor, you will pay all costs at the time of
service and submit a claim for reimbursement.

EyeMed Vision
Plan Name PPO
Network Name Insight Network Non-Network
Vision Benefits
Copay
- Examination (Every 12 Months) $20 Up to $50 Reimbursement
- Materials $20 $20
Lenses (Every 12 Months)
- Single Vision No Charge Up to $48 Reimbursement
- Bifocal No Charge Up to $67 Reimbursement
- Trifocal No Charge Up to $86 Reimbursement
Frames (Every 24 Months) Up to $130 allowance Up to $91 Reimbursement
Contact Lenses (Every 12 Months) (in lieu of lenses)
- Elective Up to $120 allowance Up to $105 Reimbursement
- Fitting and Follow up Up to $40 Not Covered
Laser Vision Correction 15% off retail price or 5% off the 15% off retail price or 5% off the
promotional price promotional price

Employee contribution per pay date
- Employee $1.81
- Employee + family $4.47

VISION VALUE-ADDS

FINDING A VISION PROVIDER: • Freedom Pass at Target - Any frame, any price for $0 out-of-pocket at
Target Optical. Flyer must be provided to redeem offer
• Members will receive a 20% discount on remaining balance at partici-
Contact EyeMed member services at 1-866- pating providers beyond plan coverage; this does not pertain to dis-
804-0982
Go to www.eyemedvisioncare.com and click posable contacts.
on “Find a Provider” and enter zip code • Save 15% off the retail price or 5% off the promotional price for LASIK
• Select Insight Network or PRK procedures.
• Discounts on hearing aids and exams through Amplifon
• With Sun Perks through EyeMed, you'll receive $20 off any purchase,
or $50 off a purchase of $200 or more toward premium, non-
prescription sunglasses at Sunglass Hut (some limitations apply, see
the flyer on the benefits website for more details).

RIA EMPLOYEE BENEFITS 2020 15