Agencies
Services
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 for reimbursement when an out-of-network provider is used.
FY2023 Plan Year
| Service | In-Network | Out-of-Network** | Frequency |
|---|---|---|---|
| Eye Exam | $30 copayment | $30 allowance | Once every 12 months |
|
Standard Frames
|
$30 copayment (up to $175 retail frame cost; member responsible for balance over $175) |
$70 allowance
|
Once every 24 months |
| Vision Lenses* (single, bifocal and trifocal) |
$30 copayment
|
$50 allowance for single vision lenses
$80 allowance for bifocal and trifocal lenses
|
Once every 12 months |
| Contact Lenses (all contact lenses are in lieu of spectacle lenses) |
$120 allowance | $120 allowance | Once every 12 months |
* Vision Lenses: Member pays 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.