EyeMed Vision Care Plan
The EyeMed Vision Care Plan provides access to both private practice and retail chain providers that provide quality eye care and materials. This plan is designed to provide regular eye examinations and benefits toward vision care expenses, including glasses or contact lenses.
Benefits Summary
Plan Documents & Resources
Exclusions & Limitations
FAQs
Contact Info
Phone #’s:
– Enrolled: (866) 804-0982
– Not Enrolled: (866) 800-5457
Service Hours (EST):
| M-F | 7:30am – 11pm |
| SAT | 8am – 11pm |
| SUN | 11am – 8pm |
Summary of Benefits
EyeMed Vision Plan In-Network
- The eye exam, contact lenses (new or replacement), or lenses are provided once every calendar year regardless of prescription change. Frames are provided once every calendar year.
- Your out-of-pocket cost for the service rendered is paid by you upon receipt of services. Oversize lenses, tinted lenses, sunglasses, and nonstandard and photochromatic lenses may be purchased with an additional charge. Contact lenses are in lieu of lenses.
- There is no annual deductible with this plan.
How to use the EyeMed Vision In-Network Plan Benefits:
Using a Network Provider
- A list of participating optometrists and ophthalmologists can be accessed through eyemed.com. Benefits listed are valid at all participating eye doctors.
- Identification cards are not needed. Your eligibility for service is verified by identifying yourself as an EyeMed Vision Care Plan participant when you make an appointment with a participating eye doctor.
- The provider will handle all claim filing with EyeMed.
EyeMed Vision Out-of-Network Plan:
- You are responsible for payment of the entire fee. There will be a one-time reimbursement by the EyeMed Vision Plan up to the amounts listed on chart.
- The vision exam is provided once every calendar year, with a maximum $40 reimbursement.
- Lenses are provided once every calendar year, if needed, as determined by your optometrist or ophthalmologist.
- Frames are provided once every 12 months, if needed. Frames are limited to a maximum $45 benefit.
- Contact lenses will be provided once every 12 months under the plan, if needed, as determined by your optometrist or ophthalmologist. Payment will be made for only one pair of lenses, either single, bifocal, trifocal, or contacts during the calendar year. No lens benefits are available during the calendar year that contact lenses are elected.
How to use the EyeMed Vision Out-of-Network Plan Benefits:
- EyeMed Vision Out-of-Network vision benefits are valid at any licensed ophthalmologists, optometrists, optometrist, or optician.
- Visit www.eyemed.com and complete the claim form either online or by printing and mailing itemized receipts to EyeMed. Claim forms must be submitted within 15 months of the date of service. For complete terms and conditions, review the claim form.
Vision Plan General Exclusions
No benefits will be paid for services or materials connected with or changes arising from:
- Orthoptic or vision training, subnormal vision aids and any associated
supplemental testing; Aniseikonic lenses; - medical and/or surgical treatment of the eye, eyes or supporting structures;
- any Vision Examination, or any corrective eyewear required by a Policyholder
as a condition of employment; safety eyewear; - services provided as a result of any Workers’ Compensation law, or similar legislation, or required by any governmental agency or program whether federal, state or subdivisions thereof;
- plano (non-prescription) lenses;
- non-prescription sunglasses;
- two pair of glasses in lieu of bifocals;
services or materials provided by any other group benefit plan providing vision care; - services rendered after the date an Insured Person ceases to be covered under the Policy, except when Vision Materials ordered before coverage ended are delivered, and services rendered to the Insured Person are within 31 days from the date of such order; or
- lost or broken lenses, frames, glasses, or contact lenses will not be replaced except in the next Benefit Frequency when Vision Materials would next become available.
EyeMed.com and Mobile App
Check in at eyemed.com and become a registered member. You can also use the EyeMed “Know Before You Go” tool estimator or download the EyeMed mobile app from the Apple App Store or Google Play Store. The app allows you to:
- See benefits and eligibility at-a-glance
- Track your claims
- Grab special offers to help you save more
- Find an in-network eye doctor with the Provider Locator
- View your ID card at-a-shake (mobile app only)
- Set upcoming exam and contact lens replacement reminders
- Get answers to your FAQs
EyeMed Vision Care Plan
The Plan offers in-network and out-of-network benefits. When using a participating network provider, you pay a modest copayment for exam and materials as shown in the Schedule of Benefits.
The out-of-network benefit allows you to select any licensed non-network provider. As the plan participant, when visiting a non-network provider, you pay the full fee to the provider and EyeMed Vision will reimburse you for services rendered up to the maximum allowance. There are no copays or deductibles when using an out-of-network provider.
Your benefit includes annual eye exam coverage, eye glasses or contact lenses. In-network for frames there is no member cost up to the $180 allowance. In-network for contact lenses there is no member cost up to the $150 allowance. The standard contact lens fit and follow-up member fees will not exceed $40. See Schedule of Benefits below for further details and out-of-network reimbursement amounts.
Plan Documents & Resources
Limitations and Exclusions
No benefits will be paid for services or materials connected with or changes arising from:
- Orthoptic or vision training, subnormal vision aids and any associated
supplemental testing; Aniseikonic lenses; - medical and/or surgical treatment of the eye, eyes or supporting structures;
- any Vision Examination, or any corrective eyewear required by a Policyholder
as a condition of employment; safety eyewear; - services provided as a result of any Workers’ Compensation law, or similar legislation, or required by any governmental agency or program whether federal, state or subdivisions thereof;
- plano (non-prescription) lenses;
- non-prescription sunglasses;
- two pair of glasses in lieu of bifocals;
services or materials provided by any other group benefit plan providing vision care; - services rendered after the date an Insured Person ceases to be covered under the Policy, except when Vision Materials ordered before coverage ended are delivered, and services rendered to the Insured Person are within 31 days from the date of such order; or
- lost or broken lenses, frames, glasses, or contact lenses will not be replaced except in the next Benefit Frequency when Vision Materials would next become available.