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vIsIon / eap

EyEMED PPo viSion Plan
The EyeMed Vision plan provides professional vision care and high quality lenses and frames through a broad
network of optical specialists. The EyeMed network includes access to private practice and optical retail locations,
including LensCrafters®, Target Optical, Sears Optical, JCPenney Optical and Pearle Vision. 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. You may access your plan by providing your eye doctor with a member’s
name and date of birth.

PPo
neTwoRk neTwoRk non-neTwoRk
Copay $10 exam n/A
$25 Materials
exam 100% Up to $35 Reimbursement
Every 12 Months from the Date of Service
Lenses
Every 12 Months from the Date of Service
Single Vision 100% Up to $35 Reimbursement
Bifocal 100% Up to $49 Reimbursement
Trifocal 100% Up to $74 Reimbursement
Frames $130 Allowance Up to $65 Reimbursement
Every 24 Months from the Date of Service
elective Contact Lenses $130 Allowance Up to $104 Reimbursement
In Lieu of Frames and Lenses
Every 12 Months from the Date of Service

EMPloyEE ratE PEr PayChECk
(based on 26 pay periods)
Employee Only $.98
Employee + Spouse $2.30
Employee + Child(ren) $2.45
Employee + Family $3.83

Cigna EMPloyEE aSSiStanCE PrograM
The Employee Assistance Program (EAP) provides all employees and their 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. Employees and their
immediate family members can receive up to 3 counseling sessions per person, per problem, per year.

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