Vision Plan

Waters offers you the EyeMed Vision Plan, which provides routine exams and eye-wear at discounted rates when you receive care within EyeMed’s nationwide Insight Plan H network of vision care providers.

EyeMed Vision Plan Showing in-network pricing only. The full plan summary, including out of network coverage, is located HERE.
Network	INSIGHT Plan H network
Premium/rates	Employee only	$4.32/paycheck (bi-weekly rate) OR $4.68 (semi-monthly rate) ($112.32/year)
	Employee + children	$7.44/paycheck (bi-weekly rate) OR $8.06 (semi-monthly rate) ($193.44/year)
	Employee + spouse/partner	$8.04/paycheck (bi-weekly rate) OR $8.71 (semi-monthly rate) ($209.04/year)
	Family	$11.88/paycheck (bi-weekly rate) OR $12.87 (semi-monthly rate) ($308.88/year)
Routine Eye Exams Once per calendar year	100% covered
Retinal Imaging	Up to $39 copay
Frames Once every other calendar year	First $130, fully covered Balance after $130, 20%/80% coinsurance
Lenses Once per calendar year	Single, Bifocal, Trifocal, Lenticular	$20 copay
	Standard Progressives	$85 copay
		$105-$130 copay
Contacts Once per calendar year Contact Fit and Follow Up Contact Fit and Follow Up	Conventional Standard Premium	First $150, fully covered Balance after $150, 15%/85% coinsurance Up to $40 contact lens fit and two follow up visits 10% off retail price
	Disposable	First $150, fully covered Balance after $150, no coverage
	Medically Necessary	100% Covered
Laser Vision Correction LASIK or PRK from U.S. Laser Network	Retail Price	15% Discount
	Promotional Price	5% discount

For more details, including costs for additional services, out-of-network coverage, and provider search details, review the Vision Plan HERE, Vision Summary Plan Description (SPD), or go to www.eyemed.com, or call 1-866-804-0982.

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Vision Plan

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