Vision Coverage

Need glasses or contacts? The Vision Plan can help.

EyeMed Vision You Pay:	EyeMed Vision Plan Pays Up To:
In-Network	Out-of-Network
Exams (Once every 12 months)
$15 copay	$40
Glasses¹
Single Vision Lenses
$20 copay	$25
Bifocal Lenses
$20 copay	$40
Trifocal Lenses
$20 copay	$65
Standard Progresive Lenses
$20 copay	$55
Premium Progresive Lenses
$20 copay, then anything over $120 you receive a 20% discount	$65
Lens Options
UV Treatment, Tint (Solid and Gradient), Standard Plastic Scratch Coating
$0	$8
Standard Polycarbonate — Adults and kids under 19
$0	$20
Standard Anti-Reflective Coating
$45 copay	N/A
Polarized
20% off retail price	N/A
Other Add-Ons
20% off retail price	N/A
Frames¹
$0 Copay; $130 Allowance (you receive a 20% discount on amount over $130)	$65
Conventional and Disposable Contact Lenses¹
$0 Copay; $130 Allowance (you receive a 20% discount on amount over $130)	$104
Medically Necessary
$0	$200
Contacts – Fittings
Standard
$0	$40
Premium
$0 Copay; $55 Allowance (you receive a 20% discount on amount over $55)	$40
LASIK/PRK Procedures
You receive a 15% discount on usual and customary fees at LCA-Vision locations or a 5% discount on promotional pricing, whichever is greater	You receive a 15% discount on usual and customary fees at LCA-Vision locations or a 5% discount on promotional pricing, whichever is greater

1. Lenses or contacts once every 12 months. Frames once every 12 months.

You – $3.30

You + Spouse/Domestic Partner ¹– $6.24

You + Child(ren) – $6.60

You + Family – $8.62