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” under Members & Consumers. 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 | $130 allowance, then balance | 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.
