Greeley-Evans School District 6
School District
Individuals Covered | Monthly Premium | Your Cost Per Month |
---|---|---|
Employee Only | $6.32 | $0.00 |
Employee + Spouse | $10.03 | $3.71 |
Employee + Child(ren) | $10.52 | $4.20 |
Family | $15.75 | $9.43 |
Type of Service | In-Network | Out-of-Network |
---|---|---|
Exam - Every 12 months | $10 copay | Reimbursed up to $40 |
Lenses - Every 12 months | Yes | Yes |
Single Lenses | $25.00 copay | Reimbursed up to $40 |
Lined Bifocal Lenses | $25.00 copay | Reimbursed up to $60 |
Lined Trifocal Lenses | $25.00 copay | Reimbursed up to $80 |
Lenticular Lenses | $25.00 copay | Reimbursed up to $80 |
Frames - Every 12 months | $150 allowance then 20% off balance over $150 | Reimbursed up to $45 |
Contacts (in lieu of glasses) - Every 12 months | Yes | Yes |
Medically Necessary Contacts | $0 copay; paid in full | Reimbursed up to $210 |
Conventional Elective Contacts | $150 allowance, 15% off balance over $150 | Reimbursed up to $125 |
Disposable Elective Contacts | $150 allowance plus balance over $150 | Reimbursed up to $125 |
Laser Vision Correction | 15% off retail price or 5% off promotional price | In-network only |
Please note, you may receive an ID card in the mail from EyeMed; however, it is not required to receive services. You are identified by the subscriber's SSN.
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