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Pearle Vision insurance information

We Work With All Major Health & Vision Plans Including

We Work With All Major Health & Vision Plans

At Pearle Vision, we understand that navigating your vision benefits is not always easy.

That’s why we are here to help you. We want you to feel confident that you are taking full advantage of all your Insurance plan has to offer.

We’ve created a quick guide of a few common terms to help you easily understand the basics of your vision benefits.

What is an Allowance? An allowance is the fixed amount the plan covers on the purchase of frames and/or other eyewear.

How do I find out how much will I pay out-of-pocket? This depends on your individual benefits and the eyewear you select. Understanding your copay and allowance is the first place to start. Be sure to check out your full benefit summary to confirm the benefits your plan covers.

What is a Copay? It is the fixed amount of money you pay to the doctor at the time of your visit. Co-pays vary based on your specific plan.

What is coverage? The eye care services and materials listed as benefits in your vision insurance plan.

What is a deductible? The amount you must pay for vision care services before your vision plan pays its portion of the costs. Typically, insurance plans have yearly deductible amounts.

What are Exclusions? Eye care services that are not covered by your insurance plan.

EYEMED VISION CARE BENEFIT (SAMPLE PURPOSES ONLY*)
Service Type Allowed Frequency - Adults Allowed Frequency - Kids
Exam Once every 12 months from the date of service Once every 12 months from the date of service
Lenses Once every 12 months from the date of service Once every 12 months from the date of service
Frames Once every 12 months from the date of service Once every 12 months from the date of service
Contact Lenses Once every 12 months from the date of service Once every 12 months from the date of service
Contact Lenses Fit & Follow-up Once every 12 months from the date of service Once every 12 months from the date of service
(Plan allows the member to receive either contacts and frame, or frame and lensservices)
Vision Care Services Member Cost In-Network Out-of-Network Member Reimbursement
Exam Services
Exam with Dilation as Necessary $15 Copay Up to $40
Contact Lens Fit and Follow-Up
Fit and Follow-up Standard $0 Copay Up to $40
Fit and Follow-up Prem $0 Copay; 10% off Retail Price less $55 Allowance Up to $40
Frames
Frame $0 Copay; 20% off balance over $130 Allowance Up to $50
Lenses
Single Vision $15 Copay Up to $40
Bifocal $15 Copay Up to $60
Trifocal $15 Copay Up to $80
Lenticular $15 Copay Up to $80
Progressive Standard $80 Copay Up to $60
Progressive Prem Tier 1 - 3 $100 - $125 Copay Up to $60
Progressive Prem Tier 4 $80 Copay; 20% off Retail Price less $120 Allowance Up to $60
Lens Options
Anti Reflective Coating Standard $45
Anti Reflective Coating Prem Tier 1 - 2 $57 - $68
Anti Reflective Coating Prem Tier 3 20% off Retail Price
Photochromic Plastic $75
Polycarbonate Standard $40
Scratch Coating Standard Plastic $0 Copay Up to $11
Tint Solid or Gradient $0 Copay Up to $11
UV Treatment $0 Copay Up to $11
All Other Lens Options 20% off Retail Price
Contact Lenses
Contacts Conventional $0 Copay; 15% off balance over $150 Allowance Up to $150
Contacts Disposable $0 Copay; 100% off balance over $150 Allowance Up to $150
Contacts Medically Necessary $0 Copay Up to $210
Other
Doctor Misc Materials 20% off Retail Price
Hearing Care From Amplifon network Discounts on hearing exam and aids; call 1-844-526-5432
Lasik or PRK from U.S. Laser Network 15% off retail or 5% off promo price; call 1-800-988-4221

No benefits will be paid for services or materials connected with or charges arising from: orthoptic or vision training,subnormal vision aids and any associated supplemental testing; Aniseikonic lenses; medical and/or surgical treatment of the eye, eyes or supporting structures; services provided as a result of any Workers' Compensation law, or similar legislation, or required by any governmental agency or program whether federal, state or subdivisions thereof; any Vision Examination, or any corrective eyewear required by a Policyholder as a condition of employment; safety eyewear; plano (non-prescription) lenses;non-prescription sunglasses; two pair of glasses in lieu of bifocals; services or materials provided by any other group benefit plan providing vision care; services rendered after the date an Insured Person ceases to be covered under the Policy, except when Vision Materials ordered before coverage ended are delivered, and the services rendered to the Insured Person are within 31 days from the date of such order; or lost or broken lenses, frames, glasses, or contact lenses will not be replaced except in the next Benefit Frequency when Vision Materials would next become available. Member receives a 20% discount on items not covered by the plan at EyeMed In-Network locations. Discount does not apply to EyeMed Provider's professional services, or contact lenses. Plan discounts cannot be combined with any other discounts or promotional offers. In certain states membersmay be required to pay the full retail rate and not the negotiated discount rate with certain participating providers. Please see EyeMed's online provider locator to determine which participating providers have agreed to the discounted rate. Discounts on vision materials may not be applicable to certain manufacturers' products EyeMed Vision Care reserves the right to make changes to the products on each tier and the member out-of-pocket costs. Fixed pricing is reflective of brands at the listed product level. All providers are not required to carry all brands at all levels. Service and amounts listed above are subject to change at any time. Fees charged by a Provider for services other than a covered benefit must be paid in full by the Insured Person to the Provider. Such fees or materials are not covered under the Policy. Benefit allowances provide no remaining balance for future use within the same Benefit Frequency.

*Details listed in Eyemed Vision Care Benefit table are for reference purposes only. Actual costs and details may vary.

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