Vision

Vision

Associates of Nant and its affiliates have a choice of two visions plans.  You are eligible to participate in either of the EyeMed Vision Plan highlighted in the charts below for yourself and, if you wish, your eligible dependents.  The chart below illustrates how the vision plan works and how each type of service is covered by the vision plan. Refer to vision benefit summary from EyeMed for more details.

EYEMED VISION CAREEyeMed Vision Plan Base Plan
In-NetworkNon-Network
Frequency
ExamOnce Every 12 months
Lenses or Contact LensesOnce Every 12 months
FramesOnce Every 24 months
Plan BenefitsYou PayYou Pay
Exam With Dilation as Necessary$10 CopayPlan pays up to $30
Frames$0 copay; $120 allowance. 20% off balance over $120Plan pays up to $60
Lenses
Single Vision$25 CopayPlan pays up to $25
Bifocal$25 CopayPlan pays up to $40
Trifocal$25 CopayPlan pays up to $60
Contact Lenses
Standard Contact Lens Fit & Follow-UpUp to $40Not Covered
Premium Contact Lens Fit & Follow-Up10% off retailNot Covered
Conventional$0 copay; $120 allowance. 15% off balance over $120Plan pays up to $96
Medically Necessary$0 Copay; Paid in FullPlan pays up to $210

Vision Base Plan Benefit Summary

EYEMED VISION CAREEyeMed Vision Plan Enhanced Plan
In-NetworkNon-Network
Frequency
ExamOnce Every 12 months
Lenses or Contact LensesOnce Every 12 months
FramesOnce Every 12 months
Plan BenefitsYou PayYou Pay
Exam With Dilation as Necessary$10 CopayPlan pays up to $30
Frames$0 Copay; $200 allowance. 20% off balance over $200Plan pays up to $100
Lenses
Single Vision$25 CopayPlan pays up to $25
Bifocal$25 CopayPlan pays up to $40
Trifocal$25 CopayPlan pays up to $60
Contact Lenses
Standard Contact Lens Fit & Follow-UpUp to $40Not Covered
Premium Contact Lens Fit & Follow-Up10% off retailNot Covered
Conventional$0 Copay; $200 allowance. 15% off balance over $200Plan pays up to $160
Medically Necessary$0 Copay; Paid in FullPlan pays up to $200

Vision Enhanced Plan Benefit Summary

To optimize your vision plan EyeMed Vision Care, be sure to visit their online provider finder to look up participating providers within your network.  Go to www.eyemedvisioncare.com select “Find a Provider”, enter your zip code, then choose the “Select” network, and select “Get Results” to begin your search.

 

 

Claims can be filed online at www.eyemed.com, or complete the attached form and send to the following address:

First American Administrators, Inc.
Attn: OON Claims
P.O. Box 8504
Mason, OH 45040-7111
EyeMed Claim Form