Benefits at a Glance
Vision Benefits are offered to Dependent Children to the age of 26. Coverage will end at the end of the month that a covered dependent turns 26 years of age.
Getting an eye exam is beneficial to your health! – Getting an eye exam is more than just testing your vision. Eye exams can assist in the early detection of vision conditions and health conditions such as: Glaucoma, Diabetes, Cataracts, High Blood Pressure, and Astigmatism. That’s why it’s important to get an eye exam on a regular basis. Children need eye exams, too! Did you know the American Optometric Association recommends that children receive an eye exam as early as six months of age? Our nationwide provider network will be happy to assist you in servicing your vision care needs.
This plan is insured and administered by EyeMed.
Plan Details
Create a member account at EyeMed.com
Everything is right there in one spot. Check claims and benefits, see special offers and find an eye doctor – search for one with the hours, location and brands you want. For maximum mobility, try the EyeMed Members App (Google Play or App Store).
Rates
| Coverage Tier | Weekly | Semi-Monthly |
| Employee Only | $1.60 | $3.46 |
| Employee + 1 Dependent | $2.86 | $6.19 |
| Employee + 2 or More Dependents | $4.25 | $9.20 |
Schedule of Benefits
EyeMed Vision Care’s Network consists of private practicing optometrists, ophthalmologists, and opticians.
Covered Persons have the right to obtain vision care from the Provider of their choice. However, payment of the Benefit varies depending on the type of Provider chosen. Benefits are payable as shown in the following schedule:
| Service | Preferred Provider | Non-Preferred Provider Reimbursement |
| Eye Examination | $10 co-pay | Up to $40 |
| Standard Single Vision | $25 copay | Up to $30 |
| Standard Bifocal | $25 copay | Up to $50 |
| Standard Trifocal | $25 copay | Up to $70 |
| Standard Lenticular | $25 copay | Up to $70 |
| Standard Progressive Lenses | $80 copay | Up to $50 |
| Lens Options | ||
| Basic Polycarbonate | $0 copay | $10.00 |
| Tints | $0 copay | $4.00 |
| Scratch Coat | $0 copay | $5.00 |
| UV Coating | $0 copay | $6.00 |
| Anti-Reflective Coating | $0 copay | $24.00 |
| Frames | $0 copay; 20% off balance over $150 allowance |
Up to $105 |
| Contact Lenses | In lieu of frame & lenses | |
| Conventional | $0 copay; 15% off balance over $130 allowance |
Up to $91 |
| Disposable | $0 copay; 100% of balance over $130 allowance |
Up to $91 |
| Medically Necessary | $0 copay; paid-in-full | Up to $300 |
| Co-pays | ||
| Eye Examinations | $10 | Up to $40 |
| Materials (Frames & Lenses) |
$0 copay; 20% off balance over $150 allowance |
Up to $105 |
| Frequency | ||
| Exams | Once every plan year | |
| Frames | Once every other plan year | |
| Lenses | Once every plan year | |
| Contact Lenses in lieu of Standard Lenses | Once every plan year |
