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    EyeMed Benefits Summary

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    nikhil
    This document outlines vision insurance benefits for Cognizant Vision Care Services. It provides details on in-network and out-of-network costs for exams, frames, lenses, contacts, and laser vision correction. For example, an exam has a $10 copay in-network and reimburses up to $46 out-of-network. Frame coverage is $0 copay with a $130 allowance in-network and up to $47 reimbursement out-of-network. The document also gives an example of potential savings of over 85% when using in-network benefits to purchase glasses.

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    Download as PDF, TXT or read online from Scribd

    EyeMed Benefits Summary

    Uploaded by

    nikhil
    608 views2 pages
    This document outlines vision insurance benefits for Cognizant Vision Care Services. It provides details on in-network and out-of-network costs for exams, frames, lenses, contacts, and laser vision correction. For example, an exam has a $10 copay in-network and reimburses up to $46 out-of-network. Frame coverage is $0 copay with a $130 allowance in-network and up to $47 reimbursement out-of-network. The document also gives an example of potential savings of over 85% when using in-network benefits to purchase glasses.

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    This document outlines vision insurance benefits for Cognizant Vision Care Services. It provides details on in-network and out-of-network costs for exams, frames, lenses, contacts, and laser vision correction. For example, an exam has a $10 copay in-network and reimburses up to $46 out-of-network. Frame coverage is $0 copay with a $130 allowance in-network and up to $47 reimbursement out-of-network. The document also gives an example of potential savings of over 85% when using in-network benefits to purchase glasses.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    608 views2 pages

    EyeMed Benefits Summary

    Uploaded by

    nikhil
    This document outlines vision insurance benefits for Cognizant Vision Care Services. It provides details on in-network and out-of-network costs for exams, frames, lenses, contacts, and laser vision correction. For example, an exam has a $10 copay in-network and reimburses up to $46 out-of-network. Frame coverage is $0 copay with a $130 allowance in-network and up to $47 reimbursement out-of-network. The document also gives an example of potential savings of over 85% when using in-network benefits to purchase glasses.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Cognizant

    Vision Care
    Services

    In-Network
    Member Cost

    Out-of-Network
    Reimbursement

    Exam With Dilation as Necessary

    $10 Copay

    Up to $46

    _____________________________

    More,
    for less...

    40%
    OFF
    Complete pair
    of prescription
    eyeglasses

    20%
    20%

    OFF
    Non-prescription
    sunglasses

    OFF
    Remaining balance
    beyond plan coverage
    These discounts are for
    in-network providers only

    Hello,
    Neighbor
    Youre on the INSIGHT
    Network
    For a complete list of
    providers near you, use
    our Provider Locator on
    www.eyemed.com and
    choose the INSIGHT
    network or call
    1-844-629-5104.

    _________________________________________

    _________________

    Contact Lens Fit and Follow-Up (Contact lens fit and two follow up visits are available once a comprehensive eye exam has been completed)
    Standard Contact Lens Fit & Follow-Up
    Premium Contact Lens Fit & Follow-Up

    Up to $55
    10% off retail

    N/A
    N/A

    Retinal Imaging

    Up to $39

    N/A

    Frames

    $0 Copay; $130 allowance; 80% of charge over $130

    Up to $47

    Standard Plastic Lenses


    Single Vision
    Bifocal
    Trifocal
    Standard Progressive Lens
    Premium Progressive Lens
    Tier 1
    Tier 2
    Tier 3
    Tier 4
    Lenticular

    $10 Copay
    $10 Copay
    $10 Copay
    $75
    $95 - $120
    $95
    $105
    $120
    $75 Copay, 80% of charge less $120 Allowance
    $10 Copay

    Up to $45
    Up to $65
    Up to $85
    Up to $65
    Up to $65
    Up to $65
    Up to $65
    Up to $65
    Up to $125

    Lens Options (paid by the member and added to the base price of the lens)
    UV Treatment
    $15
    Tint (Solid and Gradient)
    $0
    Standard Plastic Scratch Coating
    $0
    Standard Polycarbonate
    $0
    Standard Polycarbonate - Kids under 19
    $0
    Standard Anti-Reflective Coating
    $45
    $57 - $68
    Premium Anti-Reflective Coating
    Tier 1
    $57
    Tier 2
    $68
    Tier 3
    80% of charge
    Photochromic/Transitions
    $0
    Polarized
    20% off retail price
    Other Add-Ons and Services
    20% off retail price

    N/A
    N/A
    N/A
    N/A
    N/A
    N/A
    N/A
    N/A
    N/A
    N/A
    N/A
    N/A
    N/A

    Contact Lenses
    Conventional
    Disposable
    Medically Necessary

    $0 Copay; $125 allowance; 85% of charge over $125


    $0 Copay; $125 allowance; plus balance over $125
    $0 copay, Paid in Full

    Up to $125
    Up to $125
    Up to $210

    Laser Vision Correction


    Lasik or PRK from U.S. Laser Network

    15% off the retail price or 5% off the promotional price

    N/A

    Frequency
    Examination
    Lenses or Contact Lenses
    Frame

    Once every calendar year


    Once every calendar year
    Once every calendar year

    For Lasik providers, call


    1-877-5LASER6 or
    visit eyemedlasik.com.

    Premium progressives and premium anti-reflective designations are subject to annual review by EyeMeds Medical Director and are subject to change based on market
    conditions. Fixed pricing is reflective of brands at the listed product level . All providers are not required to carry all brands at all levels.

    Whats in it for me?


    Options. Its simple really. We love our membersthats why we are dedicated to helping you
    see clearly and weve built a network that gives you lots of choices and flexibility. You can
    choose from independent doctors and retail providers to find the one that best fits your needs
    and schedule. No matter which one you choose, our plan is designed to be easy to use and to
    save you money. Welcome to EyeMed.

    eyemed.com

    Benefits Snapshot

    With Us

    Out-of-Network
    Reimbursement

    Exam with dilation as necessary (Once every calendar year)

    $10 Copay

    Up to $46

    Frames (Once every calendar year)

    $0 Copay; $130 allowance; 80% of charge over $130

    Up to $47

    Single Vision Lenses (Once every calendar year)

    $10 Copay

    Up to $45

    $0 Copay; $125 allowance; plus balance over $125

    Up to $125

    Or
    Contacts (Once every calendar year)

    And now its time for the breakdown . . .


    Heres an example of what you might pay for a pair of glasses vs. what youd pay without vision coverage.
    So, lets say you get an eye exam and choose a frame that costs $163 with single vision lenses that have
    UV and scratch protection. Now lets see the difference . . .

    85%
    SAVINGS
    with us

    With Us

    Without Insurance**

    Exam

    Exam

    $106

    Frame

    $163

    Lens

    $78

    $10 Copay

    Frame $163
    -$130 allowance
    $33
    -$6.60 (20% discount off balance)
    $26.40

    Lens

    $10 Copay
    $15 UV treatment add-on

    Total

    $23 UV treatment add-on

    +$0 Scratch coating add-on

    +$25 Scratch coating add-on

    $25

    $126

    $61.40

    Total

    $395

    Benefits are not provided from services or materials arising from: 1) Orthoptic or vision training, subnormal vision aids and any associated supplemental testing; Aniseikonic lenses; 2)
    Medical and/or surgical treatment of the eye, eyes or supporting structures; 3) Any eye or Vision Examination, or any corrective eyewear required by a Policyholder as a condition of
    employment; Safety eyewear; 4) 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; 5) Plano (non-prescription) lenses and/or contact lenses; 6) Non-prescription sunglasses; 7) Two pair of glasses in lieu of bifocals; 8) Services or
    materials provided by any other group benefit plan providing vision care 9) 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 the services rendered to the Insured Person are within 31 days from the date of such order. 10) 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. Benefits may not be combined with any
    discount, promotional offering, or other group benefit plans. Standard/Premium Progressive lens not covered-fund as a Bifocal lens. Standard Progressive lens covered-fund Premium
    Progressive as a Standard. Premium progressives and premium anti-reflective designations are subject to annual review by EyeMeds Medical Director and are subject to change based on
    market conditions. Fixed pricing is reflective of brands at the listed product level. All providers are not required to carry all brands at all levels. Benefit allowance provides no remaining
    balance for future use within the same benefit year. **Based on industry averages.

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