2018 AMIkids

VISION INSURANCE

AMIkids offers vision coverage through Blue Cross Blue Shield (Blue Cross Blue Shield). The Blue Cross Blue Shield vision plan provides you access to the EyeMed network and allows you the flexibility to see any provider, to maximize savings seek services from a EyeMed network provider. If you utilize an out-of-network provider, you’ll pay expenses at the time of service and file a claim for reimbursement. The chart below provides a brief overview of the plan and reimbursement schedule for out-of-network services. AMIkids has not raised Vision Plan premiums for FIVE years! Your vision is important to your health. Whether your vision is 20/20 or less than perfect, everyone should receive regular vision care. To find in-network providers visit www.MyHealthToolkitFL.com and hover over on the “Education Center” in the top menu and click on “Enrollment Tools”. Under Healthy Vision you will find a link for “EyeMed Provider Locator”. Get results by entering your location and select the “Access” network.

Vision EyeMed Access Network

In-Network

Out-of-Network 1

Routine Eye Exams

Every 12 months

$20 Copay

Reimbursed up to $200

Lenses 2

Every 12 months

Single Vision Bifocal Trifocal Lenticular

Reimbursed up to $200, depending on type of lenses

$40 Copay

Frames

Every 12 months

$40 Copay provides, $130 Allowance PLUS 30% off cost over the allowance

$200 allowance

Contact Lenses (in lieu of glasses)

Every 12 months

Elective Contact Lenses Preferred Non-Preferred

$40 Copay provides up to 8 boxes $40 Copay provides, $200 allowance

Reimbursed up to $200

Medically Necessary

$40 Copay

Reimbursed up to $200

1 Reimbursable amount, less applicable copay. 2 Lenses benefit listed are for a pair of lenses.

Cost for Coverage Amounts shown are per pay check ( 24 payments/year ) Vision Plan

Employee Only

EE ES EC

$ 3.74 $ 7.70 $ 6.50 $10.46

Employee + Spouse Employee + Child(ren) Employee + Family

FAM

13

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