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eRaven

 

 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

EyeMed Vision Plan

All Faculty and Staff

 

As a member, you're able to access the EyeMed’s Insight network. Whether it is an independent eye doctor, popular retailer or online option, you get the latest in advanced vision technology to see even the slightest vision issue.

Go to the EyeMed website to find an in-network provider and other services.

When you use in-network providers you receive a higher level of coverage and are only required to pay the co-pay.  No claim forms are needed when you visit in-network providers.

When you use out-of-network providers, you must pay the bill in full and file a claim for reimbursement.  Print a claim form.  

There are many different retail providers you can use for eye exams and/or to purchase eyewear. Options include LensCrafters, Pearle Vision, Target Optical, Sears Optical and JCPenney Optical.

As a member, you can combine an eye exam and purchase of new glasses and save up to 72% off on retail prices.

Vision Coverage Plan Summary

EyeMed INSIGHT

                                                                 IN-NETWORK                      OUT-OF-NETWORK

Cost

Exam

$10

Reimbursed up to $50

Materials

$25

N/A

Benefit Frequency

Exams

Once every 12 months

Lenses (in lieu of contact lenses)

Once every 12 months

Frames

Once every 24 months

Contacts (in lieu of lenses)

Once every 12 months

Covered Services – Lenses

Single Lenses

$25 Copay

Up to $50

Bifocals

$25 Copay

Up to $70

Trifocals

$25 Copay

Up to $90

Frames

$0 Copay; $130 Allowance, 20% off balance over $130

Up to $98

Covered Services – Contacts (Contacts in lieu of Frames/Lenses

Contacts – Medically Necessary

$0 Copay, Paid-in-full

Up to $210

Contacts – Elective- Conventional

$0 Copay; $130 Allowance,

5% off balance over $130

Up to $130

Contacts – Elective – Disposable

$0 Copay; $130 Allowance, plus balance over $130

Up to $130

See separate rate sheet for employee contributions rates.

 

Rates:

 

NH Staff/CGPS (12 mos)         NH Staff (10 mos)      RFF (12mos/8mos)

 

 

Detailed Plan Documents:

 

EyeMed Benefit Summary

 

Other Helpful Tools:

 

Retinal Imaging Benefit

 

EyeMed Special Offers

 

 

(866) 723-0513

www.eyemed.com

 

 

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Rindge, New Hampshire 03461