EyeMed Vision Care
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Group name: Lone Star College System
Group #: 9679028 |
EyeMed Vision Care |
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In-Network |
Out of Network |
|
Eye Exam
Eyeglass
Contact Lens |
$10 Copay
$0 Copay |
Up to $40
$40 |
|
Frames
Up to $60
$61 to $80
$81 to $100
$101 to $200
Up to $120 retail |
(once every 12 months)
$0 Copay
$0 Copay
$0 Copay
20% off balance over $100
20% off balance over $100 |
Up to $45
Up to $45
Up to $45
Up to $45
Up to $45 |
|
Lenses
Single Vision
Bifocal
Trifocal
|
$10 Copay
$10 Copay
$10 Copay
|
Up to $25
Up to $40
Up to $65
|
|
Options – (plus lens prices)
Standard Progressive
Polycarbonate
Scratch Resistant Coating
Solid/Gradient Tint
UV Coating
Photochromic Glass
Glass
Anti-Reflective Coating |
$65
$40
$15
$15
$15
20% off retail price
20% off retail price
$45 |
Not Covered
Not Covered
Not Covered
Not Covered
Not Covered
Not Covered
Not Covered
Not Covered |
|
Contacts
Non-Disposable
Disposable
Medically Necessary |
Retail, Less $80 Allowance, plus.
$0 Copay
$0 Copay
$0 Copay |
$64
$64
$200 |
|
Lasik Vision Correction Program |
EyeMed is pleased to provide all EyeMed Vision Care members with a laser vision correction benefit. EyeMed and LCA-Vision have arranged to provide this benefit to all EyeMed Vision Care members through the U.S. Laser Network. Members are entitled to a 15% discount on the usual and customary fees for LASIK and PRK procedures, or a 5% discount on any promotional pricing, whichever is the greater benefit. One easy phone call to 1-877-5LASER6 begins the process of using your benefit. No claim forms are needed, making it a hassle free process for members.
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EyeMed Vision Care Monthly Premiums:
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Employee Only |
Employee (+) one |
Family coverage |
|
$8.80 |
$16.63 |
$24.38 |