Summary of EyeMed Benefits MEDICAL MUTUAL OF OHIO Sample Clauses

Summary of EyeMed Benefits MEDICAL MUTUAL OF OHIO. Carolina Care Plan Consumers Life Lake Erie Regional Council EyeMed Access Network Eye Med Vision Care Services EyeMed Access Network Non-Network1 Dependent Age Limit Determined by District Professional Services (One every 12 months) Spectacle Exam $15 copayment Any amount over spectacle exam $15 maximum Contact Lens Fit & Follow-Up Standard Premium (up to $55) 10% off of Retail Not Covered Not Covered Frame (One every 12 months) $0 copayment (Up to $100) + 20% off amount over $100 $30 maximum Lenses (Uncoated plastic) One pair every 12 months Single vision $15 copayment $10 maximum Bifocal $15 copayment $20 maximum Trifocal $15 copayment $30 maximum Lenticular $15 copayment $40 maximum Contact Lenses (In lieu of lenses) (One per every 12 month for Conventional or Medically necessary) Conventional Disposable Medically necessary $15 copayment (up to $100) +15% off of amount over $100 $40 maximum $15 copayment (up to $100) $40 maximum $15 copayment (up to $200) $75 maximum Listed below are additional ways to save through the EyeMed Vision program. Lens Options: Members also received fixed, discount prices on the lens options listed below when an EyeMed provider is used. Lens options Discounted price Lens options Discounted price Standard Progressive (no-line bifocal) $65 plus bifocal copay Standard Anti-reflective coating $45 Polycarbonate $40 Solid tint or Gradient tint $15 Scratch-resistant coating $15 Photochromic 20% off retail price Ultraviolet coating $15 Glass 20% off retail price Other Add-ons 20% off retail Contact Lenses by Mail: After initial purchases, replacement contract lenses may be obtained via the Internet at substantial savings and mailed directly to the member. Details are available at xxx.xxxxxxxxxxxxxxxx.xxx. The contact lens benefit allowance is not applicable to this service.
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