Vision Care

EyeMed Vision Care - Effective 1/1/2001
Benefit Description and Exclusions

Vision Care Services

Member Cost

Out-of-Network

Exam with Dilation as Necessary

$0Copay

Up to $40

Frames $130 Allowance

80% of retail price over $130

Up to $75
Standard Plastic Lenses

Single

$0 Copay

Up to $50

Bifocal

$0 Copay

Up to $60

Trifocal

$0 Copay

Up to $75

Basic Progressives

$0 Copay

Up to $75
Lens Options

(paid by the member and added to the base price of the lens)

UV Coating

$12

Tint (Solid and Gradient)

$12

Scratch Resistance

$12

Basic Polycarbonate

$35

Standard Anti-Reflective Coating

$45

Other Add-Ons and Services

(20% off Retail Price of the lens)
Contact Lenses

(includes fit, follow- up and materials; in lieu of frames & lenses)

Conventional

$25 Copay;
$130 Allowance
15% off balance
over $130

Up to $75

Disposables

$45 Copay;
$130 Allowance
balance
over $130

Up to $75

Medically Necessary

$25 Copay;
$130 Allowance
balance
over $130

Up to $75

**LASIK and PRK Vision Correction Procedures 15% off retail price
Frequency:

Exams

Once every 12 Months

Frames

Once every 24 months

Standard Plastic Lenses

Once every 12 months

Contact Lenses

Once every 12 months
Additional Purchases and Out-of-Pocket Discount

Member will receive a 20% discount on remaining balance at Participating Providers plan coverage, which may not be combined with any other discounts or promotional offers, and the discount does not apply to EyeMed's Providers' professional services or disposable contact lenses.

**LASIK and PRK correction procedures are provided by the U.S. Laser Network, owned by LCA-Vision. Members must first call 1-877-5LASER6 for the nearest facility and to receive authorization for the discount.

You also benefit from:
  • Your choice of independent optometrists, ophthalmologists, opticians and LensCrafters locations throughout the country
  • Significant savings on the retail price of complete pairs of eye wear
  • Additional savings on eye examinations, contact lenses, lens options and accessories, and LASIK and PRK laster vision procedures
  • No claim forms to request for in-network services
  • Frames from Luxottica, the world's leading frame manufacturer of such brands as Anne Klein, Brooks Brothers, Persol; and others
  • Member Services Representatives available to answer your questions 7 days a week, including evenings.
  • EyeMed even makes it easy for you to locate the providers most convenient for you.

Simply visit our web site at http://www.eyemedvisioncare.com/ and choose "Provider Locator" to enter your address

Call Member Services at 1-877-226-1115 and choose option "1" to enter your ZIP code

You can also call your current eye care professional to see if he or she participates in EyeMed's plans.