1. The eye exam, contact lenses (new or replacement), or lenses are provided once every calendar year regardless of prescription change. Frames are provided once every calendar year.
2. Your out-of-pocket cost for the service rendered is paid by you upon receipt of services. Oversize lenses, tinted lenses, sunglasses, and nonstandard and photochromatic lenses may be purchased with an additional charge. Contact lenses are in lieu of lenses.
3. There is no annual deductible with this plan.

Using a Network Provider

1. A list of participating optometrists and ophthalmologists can be accessed through eyemed.com. Benefits listed are valid at all participating eye doctors.
2. Identification cards are not needed. Your eligibility for service is verified by identifying yourself as an EyeMed Vision Care Plan participant when you make an appointment with a participating eye doctor.
3. The provider will handle all claim filing with EyeMed.

1. You are responsible for payment of the entire fee. There will be a one-time reimbursement by the EyeMed Vision Plan up to the amounts listed on chart.
2. The vision exam is provided once every calendar year, with a maximum $40 reimbursement.
3. Lenses are provided once every calendar year, if needed, as determined by your optometrist or ophthalmologist.
4. Frames are provided once every 12 months, if needed. Frames are limited to a maximum $45 benefit.
5. Contact lenses will be provided once every 12 months under the plan, if needed, as determined by your optometrist or ophthalmologist. Payment will be made for only one pair of lenses, either single, bifocal, trifocal, or contacts during the calendar year. No lens benefits are available during the calendar year that contact lenses are elected.

1. EyeMed Vision Out-of-Network vision benefits are valid at any licensed ophthalmologists, optometrists, optometrist, or optician.
2. Visit www.eyemed.com and complete the claim form either online or by printing and mailing itemized receipts to EyeMed. Claim forms must be submitted within 15 months of the date of service. For complete terms and conditions, review the claim form.

No benefits will be paid for services or materials connected with or changes arising from:

• Orthoptic or vision training, subnormal vision aids and any associated
  supplemental testing; Aniseikonic lenses;
• medical and/or surgical treatment of the eye, eyes or supporting structures;
• any Vision Examination, or any corrective eyewear required by a Policyholder
  as a condition of employment; safety eyewear;
• services provided as a result of any Workers' Compensation law, or similar legislation, or required by any governmental agency or program whether federal, state or subdivisions thereof;
• plano (non-prescription) lenses;
• non-prescription sunglasses;
• two pair of glasses in lieu of bifocals;
  services or materials provided by any other group benefit plan providing vision care;
• services rendered after the date an Insured Person ceases to be covered under the Policy, except when Vision Materials ordered before coverage ended are delivered, and services rendered to the Insured Person are within 31 days from the date of such order; or
• lost or broken lenses, frames, glasses, or contact lenses will not be replaced except in the next Benefit Frequency when Vision Materials would next become available.