VISION

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Vision Contributions Per Pay Period
Single	$0.60
Family	$1.90

Our vision plan covers eye exams, eyeglasses and contact lenses. Services are provided through the extensive Medical Mutual/EyeMed Vision Care network of optometrists, ophthalmologists, and other eye care professionals.

Receiving benefits from a network provider is as easy as making an appointment with the provider of your choice from the list of Medical Mutual/EyeMed Vision Care providers and giving them your membership information.

You also have the choice to use providers outside the network, but you’ll pay more for their services, and you will be generally responsible for paying the entire service fee, and then requesting reimbursement of the scheduled allowance (shown in the chart below) from Medical Mutual/EyeMed Vision Care.

NETWORK OF PROVIDERS

To find a list of network providers, contact EyeMed Vision Care at 1-866-299-1358 or visit the website.

Plan Features	Frequency	In-Network Member Cost	Out-of-Network Member Reimbursement
Exam	12 Months	$10 Copay	$35 Allowance
Lenses • Single Vision • Bifocal • Trifocal	12 Months 12 Months 12 Months	$25 Copay $25 Copay $25 Copay	$25 Allowance $40 Allowance $40 Allowance
Additional discounts for lens options are available.
Frames	24 Months	$0 Copay; $120 Allowance, 20% off balance over $120	$30 Allowance
Contact Lenses • Medically necessary • Elective	12 Months	Paid in full $135 Allowance, 15% off balance over $135	$200 Allowance $95 Allowance

Note: Once benefits are exhausted, they will reset following the last date of service based on the frequency.