Vision coverage is provided at no additional cost to members enrolled in any of the state-sponsored health plans. All members and enrolled dependents have the same vision coverage regardless of the health plan selected. Eye exams are covered once every 12 months from the last date the exam benefit was used. All other benefits are available once every 24 months from the last date used. Copayments are required. For information regarding the vision plan, contact the plan administrator, EyeMed Vision Care at (866) 723-0512, (800) 526-0844 (TDD/TTY).
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Service
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Network Provider Benefit
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Out-of-Network Provider Benefit**
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Benefit Frequency
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Eye Exam
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FY2013 - $10 copayment
FY2014 - $20 copayment
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$30 allowance
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Once every 12 months
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Spectacle Lenses*
(single, bifocal and trifocal)
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FY2013 - $10 copayment
FY2014 - $20 copayment
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$50 allowance for single vision lenses
$80 allowance for bifocal and trifocal lenses
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Once every 24 months
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Standard Frames (up to $175 retail frame cost; member responsible for balance over $175)
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FY2013 - $10 copayment
FY2014 - $20 copayment
(for frames within the benefit selection)
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$70 allowance
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Once every 24 months
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Contact Lenses
(All contact lenses are in lieu of spectacle lenses)
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$120 allowance
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$120 allowance
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Once every 24 months
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Lasik and PRK Vision Correction Procedures
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15% off retail price or 5% off promotional price, whichever is the greater benefit
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No Coverage
(available in-network only)
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Unlimited
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Low Vision Supplementary Testing
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FY2013 - $10 copayment
FY2014 - $20 copayment
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$125 allowance
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Once every 12 months
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Low Vision Aids
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100% coverage after a 25% copayment with a $1,000 maximum allowance
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100% coverage after a 25% copayment with a $1,000 maximum allowance
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Once every 12 months
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* Spectacle Lenses: Plan Participant pays any and all optional lens enhancement charges. Network providers may offer additional discounts on lens enhancements and multiple pair purchases.
** Out-of-network claims must be filed within one year from the date of service.
Updated 04/29/13