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   The Vision Plan
What Is Covered
The Vision Plan covers a variety of services. The way benefits are paid depends on whether you receive your eye care from an EyeMed network provider or a non-network provider. The following chart shows how the Vision Plan pays benefits:
How the Vision Plan Pays Benefits
Care and Service
In-Network Allowance
Non-Network Allowance
Exam*
(A complete initial vision analysis, which includes a comprehensive visual exam, including the prescription for corrective eyewear, if necessary)
100% after $10 copayment
Reimbursed up to $35
Single vision lenses* (Lenses having one part that corrects for either near vision or distant vision)
100% after $10 copayment
Reimbursed up to $25**
Bifocal vision lenses* (Lined lenses having one part that corrects for near vision, one for distant vision)
100% after $10 copayment
Reimbursed up to $40**
Trifocal lenses* (Lined lenses having one part that corrects for near vision, one for intermediate vision, and one for distant vision)
100% after $10 copayment
Reimbursed up to $55**
Frames* (the supporting structure of a pair of glasses that holds the lenses in place)
$130 allowance (a wide selection of frames are covered in full) plus 20% off balance over $130
Reimbursed up to $45
Covered lens options*
  • Standard Polycarbonate lenses
100%
Not applicable
  • Tints (Solid or Gradient)
100%
Not applicable
  • Standard Scratch Resistance
100%
Not applicable
Coatings
  • UV Coating
$15 copayment***
Not applicable
  • Standard anti-reflective coating
$45 copayment***
Not applicable
  • Standard progressive
$65 copayment***
Not applicable
Contact lenses and contact lens exam (evaluation, fit, follow-up, and materials)*
Please Note: If you choose contacts, you won't be eligible to receive lenses and a frame as a covered benefit during the same calendar year.
  • Medically necessary (as determined by the claims administrator)
100%
Reimbursed up to $210**
  • Conventional
$120 allowance plus 15% off amount over allowance
Reimbursed up to $120**
  • Disposable
$120 allowance
Reimbursed up to $120**
  • Laser vision correction: LASIK or PRK****
15% off retail price or
5% off promotional prices, whichever is lower
Not covered
* Limited to once per calendar year per covered individual.
** Non-network provider allowance is for two lenses. If only one lens is needed, allowance will be one-half the stated amount.
*** In addition to the $10 lens copayment.
**** Administered by LCA Vision.
Other discounts for eyewear are available at network providers.
  • Complete pairs of prescription glasses (lenses and frames) are available at a 40% discount once plan benefit has been used;
  • Conventional contact lenses are available at a 15% discount once the plan benefit has been used; and
  • Discounted pricing (20% off retail price) on other add-ons and services, and a 20% discount on items not covered under the plan (not including EyeMed providers' professional services or contact lenses).
When you visit an EyeMed network provider, the plan may provide certain benefits if you have severe vision problems that are not correctable with regular lenses. To receive benefits, your provider must complete and submit a Low Vision Authorization Form from EyeMed.
The following chart shows how the Vision Plan pays benefits for low vision (in-network only):
Care and Service
Benefits Paid
Low vision aids approved by the claims administrator
75%, up to a $1,000 maximum every two years*
Supplementary testing approved by the claims administrator (a complete low vision analysis and diagnosis which provides a comprehensive vision exam, including the prescription of corrective eyewear or other vision aids)
$10 copay for authorized EyeMed benefits once every calendar year
* You are responsible for paying 25% of the cost for approved low vision aids in addition to any amount over the maximum.

Benefits Effective January 1, 2008.