In-Network (EyeMed Network)
Vision Exam1,2
(Every 12 months)
$10 copay
Lenses2,3 (Single / Bifocal / Trifocal)
(Every 12 months)
$25 copay
Frames2,3
(Every 12 months)
$130 allowance + 20% off remaining balance
Contact Lenses2,3
(Medically Necessary / Elective)
(Every 12 months)
Covered in Full ($250 Max) / $130 Allowance + 15% off remaining balance
Out-of-Network
Vision Exam1,2
(Every 12 months)
Reimbursement up to $32
Lenses2,3 (Single / Bifocal / Trifocal)
(Every 12 months)
Reimbursement up to $30 / $45 / $75
Frames2,3
(Every 12 months)
Reimbursement up to $57
Contact Lenses2,3
(Medically Necessary / Elective)
(Every 12 months)
Reimbursement up to $200 / Reimbursement up to $105
- Essential medical eyecare covers unlimited office visits for eye-related conditions such as pink-eye, eye injury, and monitoring of cataracts and glaucoma.
- Frequency for vision exam, eyeglass lens, and contact lens benefits is once every 12 months; eyeglass frames benefit frequency is once every 12 months.
- The plan will not cover both glasses frames/lenses and contact lenses in the same year.
Save money on vision costs!
- 40% discount off complete additional pairs of glasses (Lenses and Frames must be purchased at the same time).
- 20% discount off eyewear accessories such as lens treatment, specialized lenses, non-prescription sunglasses and more
- Hearing Exam: a hearing indemnity benefit of $70.00. If an EPIC network provider (otolaryngologists and audiologists) is utilized, the exam is covered in full.
- Hearing Aid (per ear): A hearing device indemnity benefit of $500.00. If a member uses an EPIC Provider, EPIC has negotiated a 30-60% discount off the Manufacturer’s Suggested Retail Price (MSRP) for hearing aids however, members may seek services from any provider.
Contribution Rates
Semi-Monthly Pre-Tax Contributions (24 Pay Periods)
Payroll Rates
Semi-Monthly Pre-Tax Contributions (24 Pay Periods)
Employee Only
$0.00
Employee & Spouse
$2.54
Employee & Child(ren)
$2.92
Employee & Family
$4.43

Contact the provider of these benefits by calling this phone number or visiting this website: 866-265-4626, www.groupvisionservice.com