VISION

Resources

The following is a summary of your vision benefits. For a more detailed explanation of benefits, please refer to your Summary Plan Description (SPD), certificate of coverage or benefit summary. There is no network for vision coverage, which means you have open access to see any provider in your area. The provider just needs to reach out to EBMS for benefit and eligibility verification.

www.ebms.com
866-326-7598

	Open Access
Eye Exam
1 exam per calendar year	$100 per exam
Frames
1 frame per calendar year	$100 per frame
Lenses
1 pair per calendar year*	Single Vision – $100 per pair Bifocals – $150 per pair Trifocals – $200 per pair Lenticular Single Vision – $75 per pair Lenticular Bifocals – $125 per pair Lenticular Trifocals – $150 per pair Progressive – $150 per pair
Contact Lenses (medically necessary)
1 pair per calendar year or a one-year supply of disposable lenses up to the listed dollar maximum*	$175 per pair
Contact Lenses (elective)
1 pair per calendar year or a one-year supply of disposable lenses up to the listed dollar maximum*	$100 per pair

*Benefits available for lenses may be used for contact lenses in lieu of lenses.

VISION

VISION

Resources

Informational Videos

Vision Insurance