Vision Plan at a Glance
Here’s a look at what’s covered and what you pay. You can see any provider, but you will save money when you use Dearborn National/EyeMed in-network providers. Find an in-network provider by calling 844-323-8302 or visit dearbornnational.com/vision. You can also print a vision ID card on the site.
|Exam with dilation (Once per calendar year)||$10 copay||All amounts over $40|
|Frames (Once per calendar year)||$0, then all amounts over $2002||All amounts over $45|
|Lenses3 (Once per calendar year)|
|Single vision||$20 copay||All amounts over $40|
|Bifocal||$20 copay||All amounts over $60|
|Trifocal||$20 copay||All amounts over $80|
|Lenticular||$20 copay||All amounts over $80|
|Contact Lenses (in lieu of eyeglasses; once per calendar year)|
|Standard contact lens fit and follow-up||You get a 15% discount||No discount|
|Visually required contacts||$0 (must get prior approval)||All amounts over $210|
|Conventional or disposable contacts||$0, then all amounts over $1504||All amounts over $150|
- When you use an out-of-network provider, you must pay the cost up-front and then file a claim to be reimbursed up to the out-of-network allowance.
- You get a 20% discount on all amounts over the plan allowance.
- The plan will pay 100% for polycarbonate lenses, scratch-resistant coating, UV coating and tinting. There is an additional charge for some lens options such as some anti-reflective coatings, some progressive lenses, polarized lenses and photochromic lenses.
- You get a 15% discount on all amounts over the plan allowance.
Here are your premium costs for the Vision Plan.
|Employee only||$3.13||$6.79||Employee and children||$6.59||$14.27|
|Employee and spouse||$6.27||$13.59|