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The vision plan is administered by EyeMed.

The following is a summary of your vision benefits. For a more detailed explanation of benefits, please refer to your Summary Plan Description (SPD), certificate of coverage or benefit summary.

  Network Non-Network
Routine Eye Exam (Once every 12 months) $20 copay $30 copay
Eyeglass Frames (Once every 24 months) $130 allowance + 20% off balance Up to $50 allowance
Eyeglass Lenses (Once every 12 months)
Single Lenses
Bifocal Lenses
Trifocal Lenses
$20
$20
$20
$25 allowance
$40 allowance
$55 allowance
Contact Lenses
Conventional
Disposable
Non-Elective (Medically necessary)
$130 allowance, 15% off balance
$130 allowance
$0, paid-in-full
$105 allowance
$105 allowance
$210 allowance

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Vision Insurance

Vision Insurance