|
In-Network
( any EyeMed provider )
|
Out-of-Network
( any qualified non-network provider of your choice )
|
|
Eye Exam once every 12 months |
$ 10 copay |
$ 40 reimbursement |
Exam at PLUS Providers |
$ 0 copay |
Up to $ 40 |
Frames - once every 24 months Any available frame at PLUS Providers |
$ 0 copay ;
20 % off balance over $ 185 allowance
|
Up to $ 95 |
Any frame available at the provider ’ s location |
$ 0 copay $ 135 allowance |
$ 94.50 reimbursement |
20 % off amounts over $ 135 |
||
Lenses or Contacts - Once every 12 months Single Lenses |
$ 25 |
$ 30 reimbursement |
Bifocal Lenses |
$ 25 |
$ 50 reimbursement |
Trifocal Lenses |
$ 25 |
$ 70 reimbursement |
Conventional Contacts |
$ 0 copay $ 135 allowance 15 % off amounts over $ 135 |
$ 135 |