Summary of covered services, limitations, exclusions, and fitness program terms.
Vision benefits apply to adult members as specified; members must use EyeMed Network Providers to receive vision benefits or they are responsible for all costs.
Comprehensive Eye Exam with dilation, if medically necessary: Limited to one (1) per Benefit Year; cost share applies.
Eyewear / Contact Allowance: One eyewear allowance per Benefit Year usable for eyeglasses (frame, lenses, and lens options) or contact lenses (materials only). Conventional 15% discount applies to balance after allowance; disposable and other contact types noted in provider materials.
Supplemental Diagnostic Testing: Supplemental diagnostic testing (diagnostic evaluation beyond a comprehensive eye examination, including ocular function assessment, measurements, visual field evaluations): Limited to one (1) per Benefit Year.
Low Vision Aids: Low-vision aids (e.g., spectacle-mounted magnifiers, telescopes, hand-held and stand magnifiers, video magnification): Limited to one (1) per Benefit Year.
Medically Necessary Contact Lenses: Contact lenses determined to be medically necessary (e.g., keratoconus, aphakia, anisometropia, aniridia, corneal disorders, post‑traumatic disorders, irregular astigmatism, pathological myopia) are covered in lieu of other eyewear; when determined necessary, lenses and associated services including fit and follow-ups are covered in full with no limitation on number of follow-ups.
Retinal Imaging: Retinal imaging benefit: Covered at no member cost share; limited to one (1) per Benefit Year.
Exclusions (services not covered)
Services and materials not meeting accepted standards of optometric practice.
Replacement of lost or stolen eyewear.
Two pairs of eyeglasses in lieu of bifocals.
Non‑prescription (Plano) lenses.
Insurance of contact lenses.
State or territorial taxes on vision services.
Additional Services (not a Benefit but discounts may apply)
Laser vision correction (LASIK or PRK) is not covered; members may receive discounts (15% off retail or 5% off promotional price) through network arrangements.
Additional eyewear purchases beyond the single Benefit Year allowance are not covered but may be discounted (40% off complete eyeglass purchases and 15% off conventional contact lenses) at participating Network Providers.
Network and Provider Rules: You must use an EyeMed Network Provider to receive Benefits under this Rider; non‑network services are considered Non‑Covered and the member is responsible for all costs. Participating providers may charge their normal fee for non‑covered services and will provide cost estimates upon request.
Active & Fit Fitness Program: Active & Fit is voluntary and available to covered adults 18 and older while enrolled in the Plan for the Benefit Year; enrollment is provided at no cost and may include gym access, certain amenities (where available), one home fitness kit per Benefit Year (may include a wearable), digital workouts, on‑demand workouts, healthy living coaching, and personalized workout plans. Availability of centers and included services may vary; some amenities or upgraded services may require additional fees.
Program Limitations and Fees: Fees required for the fitness program do not count toward the Annual Out‑of‑Pocket Maximum, are non‑refundable, non‑prorated, and may be collected by a third party; enrollment is limited to the current Benefit Year and while the member remains enrolled in the Plan. Home kits and available services are subject to change and facility eligibility restrictions may apply.