Vision
The Dalton Public Schools EyeMed Vision plan provides coverage for exams, frames, and lenses (either contacts or eyeglass lenses). If you visit a participating EyeMed Vision provider, you will have a higher benefit and lower out-of-pocket costs. In order to obtain information regarding participating vision providers, access www.eyemedvisioncare.com. Next, click on “Find an eye doctor.” Select the “Insight” Network and follow search instructions. Dependent children can be covered to age 26 regardless of their student status.
If you go to a participating EyeMed provider, you will pay your portion of the bill at the time of service (no filing of claims). If you have services from a non-participating provider, you will need to pay at the time of service and file a claim with EyeMed for reimbursement. Participating vision provider information can be found on the Resources page.
| Vision Summary of Benefits | In-Network | Out-of-Network |
|---|---|---|
|
Maximum Benefit per Calendar Year
|
Not Applicable | Not Applicable |
|
Exam
|
||
| Standard (once every 12 months) | $10 copay | Plan pays up to $40 allowance |
| Contact Lens Fit and Follow-up | $40 copay | Not Covered |
|
Lenses - Glasses (once every 12 months)
|
||
| Single | Covered in full after $25 copay | Plan pays up to $30 |
| Bifocal | Covered in full after $25 copay | Plan pays up to $50 |
| Trifocal | Covered in full after $25 copay | Plan pays up to $70 |
| Lenticular | Covered in full after $25 copay | Plan pays up to $70 |
|
Frames (once every 24 months)
|
Plan pays $130 | Plan pays up to $91 |
|
Contact Lenses
|
||
| Conventional | Up to $130 allowance, then 15% off balance | Plan pays up to $130 |
| Disposable | Up to $130 allowance | Plan pays up to $130 |
| Medically necessary | Covered in full | Plan pays up to $210 |
Frequencies
- Examination: Once per 12 months
- Lenses: One pair per 12 months
- Frames: One pair per 24 months
** Either eyeglass lenses or contact lenses are allowed per frequency **
SHBP Vision Benefit
If you are enrolled in a SHBP Medical Plan, the plan covers 100% of one routine eye exam every 24 months. The plan does not extend to additional vision benefits such as eyeglasses or contact lenses.
