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Benefits

Vision Insurance

Aetna | PPO Vision Plan
The Aetna 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 Aetna.

Aetna PPO Note
Vision Plan Our Vision plan

through Aetna u lizes
Network Name Aetna Vision Network Non-Network
the EyeMed network,
Vision Benefits including access to
independent
Examina on (Every 12 Months) 100% $55 Reimbursement
ophthalmologists and
Lenses (Every 12 Months) optometrists, as well
- Single Vision 100% $30 Reimbursement as LensCra ers®,
- Bifocal 100% $45 Reimbursement Target Op cal, Sears
- Trifocal 100% $75 Reimbursement Op cal, JCPenney
- Len cular 100% $75 Reimbursement Op cal and most
- Progressive $65-$110 Copay $45 Reimbursement Pearle Vision retail
- UV Treatment $15 Copay Not Covered stores.
- Tint (Sold and Gradient) $15 Copay Not Covered
- Standard Plas c Scratch Coa ng 100% $15 Reimbursement
- Standard Polycarbonate (Adult) $40 Copay Not Covered
- Standard Polycarbonate (Children) 100% $35 Reimbursement
- Standard An -Reflec ve Coa ng $45 Copay Not Covered
- Polarized 80% of Retail Price Not Covered
Frames (Every 24 Months) $130 Benefit, $65 Reimbursement
then 20% Discount

Contact Lenses (Every 12 Months) In Lieu of Frames and Lenses
- Cosme c / Elec ve $130 Benefit, $90 Reimbursement
then 15% Discount
- Medically Necessary 100% $200 Reimbursement

Finding a Vision Provider
Go to www.aetnavision.com.

Employee Assistance Program

The Employee Assistance Program (EAP) through Aetna 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 year.

Accessing the EAP

To access EAP benefits, go to www.mylifevalues.com (User Name and Password = RESOURCES) or you may
call (855) 283-1915 to be immediately connected to an EAP counselor.

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