Vision PPO
Gain access to more than 40,000 EyeMed Vision Care® providers. Member benefits include contacts in addition to frames and lenses, as well as discounts on laser vision correction. Material plan option also available.
| |
In-Network |
Out of Network |
| Annual Eye Exam |
$10 copay |
Up to $42 |
| Fit and Follow-up Exams |
Covered in full |
Up to $40 |
| Frames |
$130 allowance
20% off amount over allowance |
Up to $65 |
| Single |
$10 copay |
Up to $35 |
| Bifocal |
$10 copay |
Up to $40 |
| Trifocal |
$10 copay |
Up to $65 |
| Progressive |
$75 copay |
Up to $40 |
| Preimum Progressive |
$75 copay, $120 allowance
20% off amount over allowance |
Up to $40 |
| Elective - Conventional |
$130 allowance
15% off amount over allowance |
Up to $104 |
| Elective - Disposable |
$130 allowance |
Up to $104 |
| Medically Necessary |
Covered in full |
Up to $200 |
| UV Coating |
$15 copay |
No benefit |
| Tint - Solid and gradient |
$15 copay |
No benefit |
| Scratch-resistant |
$15 copay |
No benefit |
| Polycarbonate |
$40 copay |
No benefit |
| Anti-reflective |
$45 copay |
No benefit |
| Other add-ons and services |
20% off amount |
No benefit |
| Frequencies in Months |
Lenses or contacts 12
Frames 12 or 24 |
Lenses or contacts 12
Frames 12 or 24 |
| |
In-Network |
Out of Network |
| Annual Eye Exam |
$10 copay |
Up to $42 |
| Fit and Follow-up Exams |
Up to $55 copay |
No benefit |
| Frames |
$130 allowance
20% off amount over allowance |
Up to $65 |
| Single |
$25 copay |
Up to $35 |
| Bifocal |
$25 copay |
Up to $40 |
| Trifocal |
$25 copay |
Up to $65 |
| Progressive |
$90 copay |
Up to $40 |
| Preimum Progressive |
$90 copay, $120 allowance
20% off amount over allowance |
Up to $40 |
| Elective - Conventional |
$130 allowance
15% off amount over allowance |
Up to $104 |
| Elective - Disposable |
$130 allowance |
Up to $104 |
| Medically Necessary |
Covered in full |
Up to $200 |
| UV Coating |
$15 copay |
No benefit |
| Tint - Solid and gradient |
$15 copay |
No benefit |
| Scratch-resistant |
$15 copay |
No benefit |
| Polycarbonate |
$40 copay |
No benefit |
| Anti-reflective |
$45 copay |
No benefit |
| Other add-ons and services |
20% off amount |
No benefit |
| Frequencies in Months |
Lenses or contacts 12
Frames 12 or 24 |
Lenses or contacts 12
Frames 12 or 24 |
| |
In-Network |
Out of Network |
| Annual Eye Exam |
$10 copay |
Up to $42 |
| Fit and Follow-up Exams |
Up to $55 copay |
No benefit |
| Frames |
$100 allowance
20% off amount over allowance |
Up to $50 |
| Single |
$25 copay |
Up to $35 |
| Bifocal |
$25 copay |
Up to $40 |
| Trifocal |
$25 copay |
Up to $65 |
| Progressive |
$90 copay |
Up to $40 |
| Preimum Progressive |
$90 copay, $120 allowance
20% off amount over allowance |
Up to $40 |
| Elective - Conventional |
$115 allowance
15% off amount over allowance |
Up to $92 |
| Elective - Disposable |
$115 allowance |
Up to $92 |
| Medically Necessary |
Covered in full |
Up to $200 |
| UV Coating |
$15 copay |
No benefit |
| Tint - Solid and gradient |
$15 copay |
No benefit |
| Scratch-resistant |
$15 copay |
No benefit |
| Polycarbonate |
$40 copay |
No benefit |
| Anti-reflective |
$45 copay |
No benefit |
| Other add-ons and services |
20% off amount |
No benefit |
| Frequencies in Months |
Lenses or contacts 12
Frames 12 or 24 |
Lenses or contacts 12
Frames 12 or 24 |
Available in
AK, AL, AR, AZ, CA, CO, DC, FL, GA, HI, ID, IL, IN, KS, KY, LA, MD, MI, MO, MS, MT, NC, ND, NE, NM, NV, OH, OK, OR, PA, SC, SD, TN, TX, UT, VA, WA and WY.
