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UNDERSTANDING
YOUR VISION PLAN
IN-NETWORK
OUT-OF-NETWORK
Eye Exam
1 every 12 months
$10 co-pay
Up to $30 allowance
Prescription Lenses
1 pair every 12 months
Single
$10 co-pay
Up to $25 allowance
Bifocal
$10 co-pay
Up to $40 allowance
Trifocal
$10 co-pay
Up to $60 allowance
Progressive
Premium
: $75 co-pay plus 80% of
charge (less $120 allowance)
Standard
:
$75 co-pay
Up to $40 allowance
Frames
1 every 12 months
Up to $140 allowance plus 20% off any
amount over allowance
Up to $70 allowance
Contact Lens
1 every 12 months in lieu of lenses and frames
Elective
Conventional
: Up to $130 allowance plus
15% off any amount over allowance
Disposable
: Up to $130 allowance
Up to $104 allowance
Fit and Follow up Exam
(Comprehensive eye exam must be
completed first)
Standard
: Up to $40 allowance
Premium
: 10% off retail price
Up to $104 allowance
Network Providers
Cohen Fashion
Eye to Eye
Lenscrafters
Pearl Vision
Sears Vision
JC Penny Optical
Semi-MonthlyContributions
Pre Tax
Post Tax
Employee
$2.10
N/A
Employee + 1
$2.89
N/A
Family
$4.99
N/A
Domestic Partner (DP)*
N/A
$0.79
DP & DP Child(ren)*
N/A
$2.89
*In addition to the post tax contributions, a portion of the premium for DP and dependents of DP will be taxable income to the employee.
These amounts are $2.97 for DP coverage only and $4.58 for DP and dependent coverage (per semi monthly pay period).
Capco is pleased to offer vision benefits through EyeMed
Vision Care. With EyeMed, you have the freedom to
choose from an extensive network of private practice
optometrists, ophthalmologists, opticians or from leading
optical retailers.
Please note that EyeMed does not issue Identification Cards.
Your provider can contact EyeMed directly to verify
benefits.
*Capco utilizes the EyeMed Select vision network.*
The Vision Care Plan through EyeMed will
help you keep your life in focus.
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