Vision coverage is provided at no additional cost to members enrolled in any of the LGHP health plans. All members and enrolled dependents have the same vision coverage regardless of the health plan selected. All vision benefits are available once every 12 months from the last date used, with the exception of frames, which are available once every 24 months. Copayments are required.

The plan administrator for the vision benefit is EyeMed. EyeMed’s Certificate of Coverage [PDF, 123KB] is available for viewing. Requests for reimbursement for services provided by an out-of-network vision provider must be submitted on an EyeMed claim form [PDF, 134KB].


Service In-Network​ ​Out-of-Network​** Frequency​
Eye Exam ​$25 copayment ​$30 allowance ​Once every 12 months
Spectacle Lenses*
(single, bifocal and trifocal)
​$25 copayment
​$50 allowance for single vision lenses
$80 allowance for bifocal and trifocal lenses
Once every 12 months​
Standard Frames
​$25 copayment
(up to $175 retail frame cost; member responsible for balance over $175)
​$70 allowance ​Once every 24 months
Contact Lenses
(all contact lenses are in lieu of spectacle lenses)
​$120 allowance ​$120 allowance ​Once every 12 months
 * Spectacle Lenses: Plan participant pays any and all optional lens enhancement charges. In-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 05/12/17