Page 10 - Evisions Benefit Guide 2020 - Effective 1.1.2020

Benefits

Vision Insurance

UNUM—EyeMed | PPO Vision Plan
The EyeMed vision plan through UNUM 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 UNUM.

UNUM—EyeMed
Plan Name PPO

Network Name EyeMed Insight Vision Network Non-Network
Vision Benefits
Copay
- Examination $10 Copay $40 Reimbursement
- Materials $10 Copay N/A
Examination (Every 12 Months) 100% Up to $60
Lenses (Every 12 Months)
- Single Vision 100% Up to $30
- Bifocal 100% Up to $50
- Trifocal 100% Up to $70
- Lenticular 100% Up to $70

Frames (Every 12 Months) $130 Allowance Up to $91
Contact Lenses (Every 12 Months) In Lieu of Frames and Lenses
- Cosmetic / Elective $130 Allowance Up to $130
- Medically Necessary 100% Up to $210
- Fitting Exam Fee $40 Copay Not Covered

Laser Vision Correction Discounts Apply Not Covered
Note
UNUM’s Vision plan utilizes the EyeMed Insight network which includes access to independent ophthalmologists and optometrists.
The Insight network offers members access to convenient, quality care with more than 71,400 access points, including independent
optometrists and retail stores like LensCrafters, JC Penney, Pearle Vision and many more!

Finding a Vision Provider
Go to www.eyemedvisioncare.com/unum or call (888) 400-9304.

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