Vision Benefits
Protect your vision with eye care coverage through EyeMed.
Vision Plan Summary
| Key Features | In-Network | Out-of-Network | Frequency |
|---|---|---|---|
| Exam | $0 copay | Reimbursed up to $40 | Once every calendar year |
| Single Vision Lenses | $25 copay | Reimbursed up to $30 | Once every calendar year |
| Bifocal Lenses | $25 copay | Reimbursed up to $50 | Once every calendar year |
| Trifocal / Lenticular Lenses | $25 copay | Reimbursed up to $70 | Once every calendar year |
| Frames | $130 allowance, then 20% off any remaining balance | Reimbursed up to $91 | Once every other calendar year |
| Contact Lenses - Conventional | $0 copay; 15% off balance over $130 allowance | Reimbursed up to $91 | Once every calendar year |
| Contact Lenses- Disposable | $0 copay; 100% of balance over $130 allowance | Reimbursed up to $91 | Once every calendar year |
| Contact Lenses - Medically Necessary | $0 copay; paid-in-full | Up to $300 | Once every calendar year |
Exam
- In-Network
- $0 copay
- Out-of-Network
- Reimbursed up to $40
- Frequency
- Once every calendar year
Single Vision Lenses
- In-Network
- $25 copay
- Out-of-Network
- Reimbursed up to $30
- Frequency
- Once every calendar year
Bifocal Lenses
- In-Network
- $25 copay
- Out-of-Network
- Reimbursed up to $50
- Frequency
- Once every calendar year
Trifocal / Lenticular Lenses
- In-Network
- $25 copay
- Out-of-Network
- Reimbursed up to $70
- Frequency
- Once every calendar year
Frames
- In-Network
- $130 allowance, then 20% off any remaining balance
- Out-of-Network
- Reimbursed up to $91
- Frequency
- Once every other calendar year
Contact Lenses - Conventional
- In-Network
- $0 copay; 15% off balance over $130 allowance
- Out-of-Network
- Reimbursed up to $91
- Frequency
- Once every calendar year
Contact Lenses- Disposable
- In-Network
- $0 copay; 100% of balance over $130 allowance
- Out-of-Network
- Reimbursed up to $91
- Frequency
- Once every calendar year
Contact Lenses - Medically Necessary
- In-Network
- $0 copay; paid-in-full
- Out-of-Network
- Up to $300
- Frequency
- Once every calendar year
Plan Notes
- To find in-network provider: www.eyemed.com: Log in and search as member, or Guest: Find an Eye Doctor > Insight Network
- Group ID: 1052609