EyeMed administers the vision benefits for the State Employee's Group Insurance Program. When plan participants utilize a network provider, the benefit levels are greater. Services provided by an out-of-network provider are paid at a lower benefit level.
Plan participants must submit an
EyeMed Claim form (PDF 80 KB) for reimbursement when an out-of-network provider is used. Specific questions regarding the vision benefit can be found in the
Certificate of Coverage (PDF 120 KB).
|Eye Exam||$25 copayment||$30 allowance||Once every 12 months|
(single, bifocal and trifocal)
$50 allowance for single vision lenses
$80 allowance for bifocal and trifocal lenses
|Once every 12 months|
(up to $175 retail frame cost; member responsible for balance over $175)
|$70 allowance||Once every 24 months|
(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.