Vision

Access to the one of the largest panels of eye care professionals
You may obtain one eye exam in a calendar year. There is no waiting period in between services from the prior year
A nominal $10 copay for an in-network routine exam
Potential payment for out-of-network benefits
Coverage for frames, lenses and contacts
Access to other savings and discounts

For More Information
Call 1.844.225.3107 or visit www.eyemed.com

Services	In-Network EyeMed Access	Out-of-Network
Exam Copay/ Out-of-network Allowance	$10	$40
Materials Copay	$10	$10
Frequency – Exam / Lenses / Frames	Once every plan year	Once every plan year
Single Lenses – After Copay/Allowance	Covered in full after copay	$30
Bifocal Lenses – After Copay/Allowance	Covered in full after copay	$50
Trifocal Lenses – After Copay/Allowance	Covered in full after copay	$70
Lenticular Lenses – After Copay/Allowance	Covered in full after copay	$70
Frames – After Copay/Allowance	$0 copay; $150 allowance, + 20% discount	$70
Contacts (Elective) – Allowance	Conventional: $0 copay; $150 +15 % off balance Disposable: $0 copay; $150	$126
Contacts (Med Nec) – After Copay/Allowance	$0 copay; Covered in Ful	$300