2017 Benefits Guide.pub

12 / 22

Fox Associates, L.L.C., Metropolitan Tickets, Inc. and Fox Theatricals, LLC
9
VISION INSURANCE
EyeMed Vision
Benefit/Service
In-Network
Benefit
Out-of-Network
Benefit
Examination $10 Co-pay $40 reimbursement
Frequency of Service:
Exam Every 12 months
Lenses Every 12 months
Frames Every 24 months
Lenses: $25 Co-pay then: Reimbursement:
Single 100% $30
Bifocal 100% $50
Trifocal 100% $70
Frames
Covered 100% up to
$150 Retail Allowance
20% Discount on Balance
$105
Contacts: Reimbursement
Necessary Covered at 100% $210
Cosmetic $150 Allowance $150
2017-2018 Employee Vision
Contributions
Vision Employee Cost Per Paycheck
Employee $0.00
Employee & Spouse $2.26
Employee & Family $4.86
Monthly
$0.00
$4.89
$10.54
Employee & Child(ren) $5.43 $2.51
EyeMed Vision offers its vision
program through a national network
including both private practice and
retail chain providers.
Always identify yourself as an
EyeMed Vision customer when
making your appointment. This will
assist your provider in obtaining a
claim authorization before your visit.
Your participating provider will help
you determine which contact lenses
are available in the EyeMed Vision
selection.
To access the Provider Locator
service, visit their web site at
to look up a
provider or call (866) 800-5457, 24
hours a day, seven days a week.