Vision Coverage

Get the most from your vision benefits.

Need glasses or contacts? The Vision Plan can help.

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What the Plan Covers

<table style=”background-color: #F2F2F2;” class=”acr-tabel-1″>
<tbody>
<tr class=”tabel-header-1″>
<td style=”text-align: center;”>EyeMed Vision<br />You Pay:</td>
<td style=”text-align: center;”>EyeMed Vision<br />Plan Pays Up To:</td>
</tr>
<tr>
<td style=”text-align: center;”>In-Network</td>
<td style=”text-align: center;”>Out-of-Network</td>
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<tr>
<td colspan=”2″><strong>Exams (Once every 12 months)</strong></td>
</tr>
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<td style=”text-align: center;”>$15 copay</td>
<td style=”text-align: center;”>$40</td>
</tr>
<tr bgcolor=”#333D47″>
<td colspan=”2″><span style=”color: #ffffff;”><strong>Glasses<sup>1</sup></strong></span></td>
</tr>
<tr>
<td class=”tr-red-bg-1″ colspan=”2″><strong>Single Vision Lenses</strong></td>
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<tr>
<td style=”text-align: center;”>$20 copay</td>
<td style=”text-align: center;”>$25</td>
</tr>
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<td colspan=”2″><strong>Bifocal Lenses</strong></td>
</tr>
<tr>
<td style=”text-align: center;”>$20 copay</td>
<td style=”text-align: center;”>$40</td>
</tr>
<tr>
<td colspan=”2″><strong>Trifocal Lenses</strong></td>
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<tr>
<td style=”text-align: center;”>$20 copay</td>
<td style=”text-align: center;”>$65</td>
</tr>
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<td colspan=”2″><strong>Standard Progresive Lenses</strong></td>
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<tr>
<td style=”text-align: center;”>$20 copay</td>
<td style=”text-align: center;”>$55</td>
</tr>
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<td colspan=”2″><strong>Premium Progresive Lenses</strong></td>
</tr>
<tr>
<td style=”text-align: center;”>$20 copay, then anything over $120 you receive a 20% discount</td>
<td style=”text-align: center;”>$65</td>
</tr>
<tr bgcolor=”#333D47″>
<td colspan=”2″><span style=”color: #ffffff;”><b>Lens Options</b></span></td>
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<td colspan=”2″><strong>UV Treatment, Tint (Solid and Gradient), Standard Plastic Scratch Coating</strong></td>
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<td style=”text-align: center;”>$0</td>
<td style=”text-align: center;”>$8</td>
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<td colspan=”2″><strong>Standard Polycarbonate — Adults and kids under 19</strong></td>
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<td style=”text-align: center;”>$0</td>
<td style=”text-align: center;”>$20</td>
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<td colspan=”2″><strong>Standard Anti-Reflective Coating</strong></td>
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<td style=”text-align: center;”>$45 copay</td>
<td style=”text-align: center;”>N/A</td>
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<td colspan=”2″><strong>Polarized</strong></td>
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<td style=”text-align: center;”>20% off retail price</td>
<td style=”text-align: center;”>N/A</td>
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<td colspan=”2″><strong>Other Add-Ons</strong></td>
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<td style=”text-align: center;”>20% off retail price</td>
<td style=”text-align: center;”>N/A</td>
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<td colspan=”2″><strong>Frames<sup>1</sup></strong></td>
</tr>
<tr>
<td style=”text-align: center;”>$0 Copay; $130 Allowance (you receive a 20% discount on amount over $130)</td>
<td style=”text-align: center;”>$65</td>
</tr>
<tr>
<td colspan=”2″><strong>Conventional and Disposable Contact Lenses<sup>1</sup></strong></td>
</tr>
<tr>
<td style=”text-align: center;”>$0 Copay; $130 Allowance (you receive a 20% discount on amount over $130)</td>
<td style=”text-align: center;”>$104</td>
</tr>
<tr>
<td colspan=”2″><strong>Medically Necessary</strong></td>
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<td style=”text-align: center;”>$0</td>
<td style=”text-align: center;”>$200</td>
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<tr bgcolor=”#333D47″>
<td colspan=”2″><span style=”color: #ffffff;”><b>Contacts – Fittings</b></span></td>
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<td colspan=”2″><strong>Standard</strong></td>
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<td style=”text-align: center;”>$0</td>
<td style=”text-align: center;”>$40</td>
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<td colspan=”2″><strong>Premium</strong></td>
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<tr>
<td style=”text-align: center;”>$0 Copay; $55 Allowance (you receive a 20% discount on amount over $55)</td>
<td style=”text-align: center;”>$40</td>
</tr>
<tr>
<td class=”tr-red-bg-1″ colspan=”2″><strong><strong>LASIK/PRK Procedures</strong></strong></td>
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<tr>
<td style=”text-align: center;”>You receive a 15% discount on usual and customary fees at LCA-Vision locations or a 5% discount on promotional pricing, whichever is greater</td>
<td style=”text-align: center;”>You receive a 15% discount on usual and customary fees at LCA-Vision locations or a 5% discount on promotional pricing, whichever is greater</td>
</tr>
</tbody>
</table>
<p style=”font-size: 12px; line-height: 18px; font-weight: 500;”>1. Lenses or contacts once every 12 months. Frames once every 12 months.</p>

What the Plan Costs

You – $3.30

You + Spouse/Domestic Partner –  $6.24

You + Child(ren) – $6.60

You + Family – $8.62

1. By law, the cost for domestic partner benefits cannot be paid pre-tax, and the “value” of Team Member and employer-provided domestic partner contributions is taxable.

Provider