State Vision Plan

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).

 

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 05/12/2017