02/18/2021 (2) - Laserfiche WebLink

Home Browse Search

City of Cocoa I Employee Benefit Highlights 12020-2021 Vision Insurance EyeMed Vision Care Plan The City offers vision insurance through EyeMed to benefit-eligible employees. Out-of-Network Benefits The costs per pay period for coverage are listed in the premium table below Employee and covered dependent(s) may choose to receive services from and a brief summary of benefits is provided on the following page. For vision providers who do not participate in the EyeMed Insight network. more detailed information about the vision plan,please refer to the carrier's When going out of network,the provider will require payment at the time of summary plan document or contact EyeMed's customer service. appointment.EyeMed will then reimburse based on the plan's out-of-network reimbursement schedule upon receipt of proof of services rendered. Vision Insurance—EyeMed Vision Care Plan 24 Bi-Weekly Deductions-Per Pay Period Cost Calendar Year Deductible Tier of Coverage 1 Employee Cost There is no calendar year deductible. Employee only $0 Calendar Year Out-of-Pocket Maximum Employee+Family $237 There is no out-of-pocket maximum.However,there are benefit reimbursement maximums for certain services. Default Benefits Benefit-eligible employees will automatically be enrolled in employee EyeMed Customer Servicer(866)939 3633 www.eyemed.com only vision coverage,unless a different tier of coverage is selected.Changes to default benefits will not be permitted until the next applicable Open Enrollment period unless employee experiences a qualifying family status change(Qualifying Event). In-Network Benefits The vision plan offers employee and covered dependent(s)coverage for routine eye care,including eye exams,eyeglasses(lenses and frames)or contact lenses. To schedule an appointment,employees and covered dependent(s)may select any network provider who participates in the EyeMed Insight network.At the time of service,routine vision examinations and basic optical needs will be covered as shown on the plan's schedule of benefits.Cosmetic services and upgrades will be additional if chosen at the time of the appointment. 19 11 ©2016,Gehring Group,Inc.,All Rights Reserved