Page 13 - publication

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.

The EyeMed
network includes
access to
Vision Benefits independent
Copay ophthalmologists
- Examination $20 Copay $0 Copay and optometrists,
- Materials $0 Copay $0 Copay as well as
LensCrafters®,
Examination (Every 12 Months) No Charge $35 Reimbursement Target Optical,

Lenses (Every 12 Months) Sears Optical,
- Single Vision No Charge $35 Reimbursement JCPenney Optical
- Bifocal No Charge $49 Reimbursement and most Pearle
- Trifocal No Charge $74 Reimbursement Vision retail
stores.
Frames (Every 12 Months) $130 Allowance, 20% $65 Reimbursement

Contact Lenses (Every 12 Months) In Lieu of Frames and Lenses
- Cosmetic / Elective $130 Allowance, 15% $104 Reimbursement
- Medically Necessary No Charge $200 Reimbursement

Go to www.eyemed.com or call (866) 723-0513. Refer to the “Access” network when prompted.

The Employee Assistance Program (EAP) through Cigna Behavioral Health provides you and your household
members with free, confidential assistance to help with personal or professional problems that may interfere
with work or family responsibilities and obligations. Services are available 24 hours a day, 7 days a week via a
toll-free nationwide number.

To access EAP benefits, go to www.cignabehavioral.com or you may call (877) 622-4327 to be
immediately connected to an EAP counselor. Refer to your employer ID—”arrowhead.”

13