Page 13 - Ria Benefits Guide 2020 FINAL National
P. 13

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

         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).



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