2017-2018 The HydraFacial Company Benefit Summary

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VI S I ON
Through our EyeMed vision plan, you’ll receive great benefits on your exam and eyewear at an
affordable price. You’ll get quality care that focuses on your eyes and overall wellness.
To find an EyeMed doctor who’s right for you, call Customer Service at (866) 723-0513 or visit
Online, you can also view your benefits, verify eligibility, and review claims status.
Key Benefits
EyeMed Vision Plan
In-Network Out-Of-Network
Vision Exam $10 copay Up to $40 allowance
Frequency Once every 12 months Once every 12 months
Eyeglass Lenses
Single Vision Lens $25 copay Up to $30 allowance
Bifocal Lens $25 copay Up to $50 allowance
Trifocal Lens $25 copay Up to $70 allowance
Frequency Once every 12 months Once every 12 months
Frames
Benefit $130 allowance* Up to $91 allowance
Frequency Once every 24 months Once every 24 months
Contacts (In-lieu of glasses)
Benefit $130 allowance Up to $130 allowance
Frequency Once every 12 months Once every 12 months
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