Page 7 - BB Dakota Benefit Summary 12-2017.pub
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Benefits





         Vision Insurance


         EyeMed Vision Care | PPO Vision Plan
         The EyeMed Vision Care 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 Vision Care.


                                                                EyeMed                             Note
                                                                PPO Plan                           The EyeMed

         Network Name                                Access                 Non‐Network            network includes
                                                                                                   access to
         Vision Benefits                                                                           independent
                                                                                                   ophthalmologists
         Copay
          ‐ Examina on (Every 12 Months)           $10 Copay             $35 Reimbursement         and optometrists, as
          ‐ Materials                              $25 Copay                    N/A                well as
                                                                                                   LensCra ers®,
         Lenses (Every 12 Months)                                                                  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
          ‐ Progressives                           $90 Copay             $49 Reimbursement         stores.
         Frames (Every 24 Months)                 $120 Benefit            $60 Reimbursement
         Contact Lenses (Every 12 Months)                In Lieu of Frames and Lenses
          ‐ Cosme c / Elec ve                     $135 Benefit           $108 Reimbursement

         Laser Vision Correc on                  Discounts Apply            Not Covered






                        Finding a Vision Provider
                        Go to www.eyemed.com or call (866) 723‐0596. Refer to the Access Network when prompted.





         Employee Assistance Program


         Anthem Blue Cross | Employee Assistance Program
         The  Employee  Assistance  Program  (EAP)  through  Anthem  Blue  Cross  provides  you  and  your  household  members  with  free,
         confiden al assistance to help with personal or professional problems that may interfere with work or family responsibili es and
         obliga ons.  Services  are  available  24  hours  a  day,  7  days  a  week  via  a  toll‐free  na onwide  number.  You  and  your  household
         members can receive up to 3 counseling sessions per person, per problem, per year.



                        Accessing the EAP

                        To access EAP benefits, go to www.anthemeap.com and enter Company Code Anthem, or you may call (877)
                        361‐7974 to be immediately connected to an EAP counselor.





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