Vision Benefits

Getting your eyes checked regularly is important even if you don’t wear glasses or contacts. We provide quality vision care for you and your family through EyeMed Vision.

Premiums

SEMI-MONTHLY / BI-WEEKLY / WEEKLY

Coverage Tier	SEMI-MONTHLY	BI-WEEKLY	WEEKLY
Employee Only	$3.18	$2.94	$1.47
Employee + Spouse	$6.29	$5.80	$2.90
Employee + Child(Ren)	$6.15	$5.68	$2.84
Employee + Family	$9.37	$8.64	$4.32

Coverage TierEmployee Only

SEMI-MONTHLY: $3.18
BI-WEEKLY: $2.94
WEEKLY: $1.47

Coverage TierEmployee + Spouse

SEMI-MONTHLY: $6.29
BI-WEEKLY: $5.80
WEEKLY: $2.90

Coverage TierEmployee + Child(Ren)

SEMI-MONTHLY: $6.15
BI-WEEKLY: $5.68
WEEKLY: $2.84

Coverage TierEmployee + Family

SEMI-MONTHLY: $9.37
BI-WEEKLY: $8.64
WEEKLY: $4.32

Coverage Details

Service	EYEMED PLUS PROVIDER	IN-NETWORK	OUT-OF-NETWORK	FREQUENCY
Exams - Copay	$0	$20	Up to $40	Once every 12 months
Lenses - Single Vision	$25 copay	$25 copay	Up to $30	Once every 12 months
Lenses - Bifocal	$25 copay	$25 copay	Up to $50	Once every 12 months
Lenses - Trifocal	$25 copay	$25 copay	Up to $70	Once every 12 months
Lenses - Lenticular	$25 copay	$25 copay	Up to $70	Once every 12 months
Contacts (in Lieu of Lenses and Frames) - Fitting and Evaluation	$25 Copay	$25 Copay	Up to $40	Once every 12 months
Contacts (in Lieu of Lenses and Frames) - Elective	Up to $250 after fitting copay	Up to $250 after fitting copay	Up to $125	Once every 12 months
Contacts (in Lieu of Lenses and Frames) - Medically Necessary	Covered in full after fitting copay	Covered in full after fitting copay	Up to $300	Once every 12 months
Frames - Allowance	Standard Frame: Up to $300 Smart Frame: Up to $350 Hearing Frame: Up to $400	Standard Frame: Up to $250 Smart Frame: Up to $300 Hearing Frame: Up to $350	Standard Frame: Up to $300 Smart Frame: Up to $350 Hearing Frame: Up to $400	Once every 12 months

ServiceExams - Copay

EYEMED PLUS PROVIDER: $0
IN-NETWORK: $20
OUT-OF-NETWORK: Up to $40
FREQUENCY: Once every 12 months

ServiceLenses - Single Vision

EYEMED PLUS PROVIDER: $25 copay
IN-NETWORK: $25 copay
OUT-OF-NETWORK: Up to $30
FREQUENCY: Once every 12 months

ServiceLenses - Bifocal

EYEMED PLUS PROVIDER: $25 copay
IN-NETWORK: $25 copay
OUT-OF-NETWORK: Up to $50
FREQUENCY: Once every 12 months

ServiceLenses - Trifocal

EYEMED PLUS PROVIDER: $25 copay
IN-NETWORK: $25 copay
OUT-OF-NETWORK: Up to $70
FREQUENCY: Once every 12 months

ServiceLenses - Lenticular

EYEMED PLUS PROVIDER: $25 copay
IN-NETWORK: $25 copay
OUT-OF-NETWORK: Up to $70
FREQUENCY: Once every 12 months

ServiceContacts (in Lieu of Lenses and Frames) - Fitting and Evaluation

EYEMED PLUS PROVIDER: $25 Copay
IN-NETWORK: $25 Copay
OUT-OF-NETWORK: Up to $40
FREQUENCY: Once every 12 months

ServiceContacts (in Lieu of Lenses and Frames) - Elective

EYEMED PLUS PROVIDER: Up to $250 after fitting copay
IN-NETWORK: Up to $250 after fitting copay
OUT-OF-NETWORK: Up to $125
FREQUENCY: Once every 12 months

ServiceContacts (in Lieu of Lenses and Frames) - Medically Necessary

EYEMED PLUS PROVIDER: Covered in full after fitting copay
IN-NETWORK: Covered in full after fitting copay
OUT-OF-NETWORK: Up to $300
FREQUENCY: Once every 12 months

ServiceFrames - Allowance

EYEMED PLUS PROVIDER: Standard Frame: Up to $300 Smart Frame: Up to $350 Hearing Frame: Up to $400
IN-NETWORK: Standard Frame: Up to $250 Smart Frame: Up to $300 Hearing Frame: Up to $350
OUT-OF-NETWORK: Standard Frame: Up to $300 Smart Frame: Up to $350 Hearing Frame: Up to $400
FREQUENCY: Once every 12 months

Plan Notes

Vision premium contributions are deducted from your paycheck on a pre-tax basis.
Your tier of coverage determines your premium.