PR - 4.2024 Employee Benefits Guide (FINAL)

The Vision Plan pays for eye exams, glasses, and contacts through Aetna. You can visit any provider of your choice, with higher benefits paid when you visit a provider in Aetna’s network. Your Aetna vision benefits are underwritten by EyeMed so you enjoy access to a large network of vision providers!

VISION PLAN

BENEFIT

IN-NETWORK

OUT-OF-NETWORK

Eye Exam

$10 copay

Up to $25 Reimbursement

Frequency Exam Lenses or contacts Frames

12 months 12 months 24 months

12 months 12 months 24 months

Frames

$140 allowance + 20% over allowance

Up to $70

Lenses Single Vision Lenses Bifocal Vision Lenses Trifocal Vision Lenses Lenticular Vision Lenses Standard Progressive Vision Lenses

Up to $10 reimbursement Up to $25 reimbursement Up to $55 reimbursement Up to $55 reimbursement Up to $25 reimbursement

$25 copay $25 copay $25 copay $25 copay $90 copay

Contact Lenses Medically Necessary Disposable Conventional

Up to $200 Up to $105 Up to $105

$0 copay $150 allowance $150 allowance +15% over allowance

IN-NETWORK DISCOUNTS x Up to 40% discount for additional pairs of eyes glasses or prescription sunglasses x 20% of non-covered vision items x 15% discount off retail or 5% discount off the promotional price for Lasik Laser Vision or PRK from U.S. Laser Network only (call 800.422.6000 ) x Member pays a discounted fee up to $39 Retinal Imaging HOW TO FIND AN IN-NETWORK VISION PROVIDER Step 1: Visit www.aetna.com Step 2: Go to Individuals on the top menu bar and click “Find a Doctor” under “For Members” Step 3: Log in with your user name and password (if you have not previously registered, you will need to click on “Register now” and create an account) Step 4: Search by name, specialty, procedure or condition and zip code or city, state

Customer Service 800.872.3862 www.aetnavision.com

For addi Ɵ onal plan informa Ɵ on, please refer to your detailed plan design. In the event of a discrepancy, the carrier Plan Document shall prevail.

QUESTIONS? Call Bene fi tsVIP at 866.293.9736

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