Vision
Healthy eyes and clear vision are an important part of your overall health and quality of life. You may enroll yourself and your eligible dependents or you may waive vision coverage. You do not have to be enrolled in medical coverage to elect vision coverage or cover the same dependents under medical and vision.
Although vision care services and supplies are covered in-network and out-of-network, your benefits are generally greater when you use in-network providers. Your costs are based on the family members you choose to cover.
EyeMed Vision PPO
Plan Information
Plan Name: EyeMed Vision PPO
Policy Number: 9731738
Effective Date: 01/01/2025
Provider Network: EyeMed Insight
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
PIH Health Network
Exams
$10 copay
Single Vision Lenses
$10 copay
Bifocal Lenses
$10 copay
Trifocal Lenses
$10 copay
Frames
$120 allowance
Contacts (in lieu of glasses)
$120 allowance (copay waived)
Frequency
Exams
Once every 12 months
Lenses
Once every 12 months
Frames
Once every 24 months
Contacts
Once every 12 months
Out-of-Network Reimbursement
Exams
Up to $49
Single Vision Lenses
Up to $45
Bifocal Lenses
Up to $65
Trifocal Lenses
Up to $85
Frames
Up to $49
Contacts (in lieu of glasses)
Up to $105
Frequency
Exams
Once every 12 months
Lenses
Once every 12 months
Frames
Once every 24 months
Contacts
Once every 12 months
In-Network
Exams
$10 copay
Single Vision Lenses
$25 copay
Bifocal Lenses
$25 copay
Trifocal Lenses
$25 copay
Frames
20% off balance over $130 allowance (copay waived)
Contacts (in lieu of glasses)
15% off balance over $130 allowance (copay waived)
Frequency
Exams
Once every 12 months
Lenses
Once every 12 months
Frames
Once every 24 months
Contacts
Once every 12 months