Vision Rates
EyeMed administers retiree vision coverage and provides in-network and out-of-network benefits.
Vision Rates
Retiree Only
- Monthly Premium
- $6.18
Retiree + Retiree Children
- Monthly Premium
- $13.00
Retiree + Retiree Spouse
- Monthly Premium
- $12.35
Retiree + Spouse + Retiree Children
- Monthly Premium
- $18.09
| Coverage Tier | Monthly Premium |
|---|---|
| Retiree Only | $6.18 |
| Retiree + Retiree Children | $13.00 |
| Retiree + Retiree Spouse | $12.35 |
| Retiree + Spouse + Retiree Children | $18.09 |
Exam at PLUS Providers
- In-Network Member Cost
- $0 copay
- Out-of-Network Member Reimbursement
- Up to $40
Exam
- In-Network Member Cost
- $0 copay
- Out-of-Network Member Reimbursement
- Up to $40
Any available frame at PLUS Providers
- In-Network Member Cost
- $0 copay; 20% off balance over $200 allowance
- Out-of-Network Member Reimbursement
- Up to $105
Frame
- In-Network Member Cost
- $0 copay; 20% off balance over $150 allowance
- Out-of-Network Member Reimbursement
- Up to $105
Contacts - Conventional
- In-Network Member Cost
- $0 copay; 15% off balance over $150 allowance*
- Out-of-Network Member Reimbursement
- Up to $105
Contacts - Disposable
- In-Network Member Cost
- $0 copay; 100% of balance over $150 allowance*
- Out-of-Network Member Reimbursement
- Up to $105
Contacts - Medically Necessary
- In-Network Member Cost
- $0 copay; paid-in-full
- Out-of-Network Member Reimbursement
- Up to $300
Single Vision Lenses
- In-Network Member Cost
- $10 copay
- Out-of-Network Member Reimbursement
- Up to $30
Bifocal Lenses
- In-Network Member Cost
- $10 copay
- Out-of-Network Member Reimbursement
- Up to $50
Trifocal Lenses
- In-Network Member Cost
- $10 copay
- Out-of-Network Member Reimbursement
- Up to $70
Lenticular Lenses
- In-Network Member Cost
- $10 copay
- Out-of-Network Member Reimbursement
- Up to $70
Progressive - Standard–Tier 4
- In-Network Member Cost
- $65/$95/$105/$120/$185 copay
- Out-of-Network Member Reimbursement
- Up to $50
Anti-Reflective Coating - Standard–Tier 3
- In-Network Member Cost
- $45/$57/$68/$85 copay
- Out-of-Network Member Reimbursement
- Up to $23
| Service | In-Network Member Cost | Out-of-Network Member Reimbursement |
|---|---|---|
| Exam at PLUS Providers | $0 copay | Up to $40 |
| Exam | $0 copay | Up to $40 |
| Any available frame at PLUS Providers | $0 copay; 20% off balance over $200 allowance | Up to $105 |
| Frame | $0 copay; 20% off balance over $150 allowance | Up to $105 |
| Contacts - Conventional | $0 copay; 15% off balance over $150 allowance* | Up to $105 |
| Contacts - Disposable | $0 copay; 100% of balance over $150 allowance* | Up to $105 |
| Contacts - Medically Necessary | $0 copay; paid-in-full | Up to $300 |
| Single Vision Lenses | $10 copay | Up to $30 |
| Bifocal Lenses | $10 copay | Up to $50 |
| Trifocal Lenses | $10 copay | Up to $70 |
| Lenticular Lenses | $10 copay | Up to $70 |
| Progressive - Standard–Tier 4 | $65/$95/$105/$120/$185 copay | Up to $50 |
| Anti-Reflective Coating - Standard–Tier 3 | $45/$57/$68/$85 copay | Up to $23 |
- * Contact lens allowance is in lieu of the frame and lens benefit.