2023-2024 Benefits Guide

VISION PLAN The EAA offers voluntary vision insurance through Blue Cross Blue Shield of Texas. Our vision benefits plan gives you the freedom to choose any in-network provider with the option to pick any frames, any lenses, and any contacts. With the right combination of retail and independent doctors, you will have access to providers with weekend and evening hours. Benefits can be applied online at Glasses.com—providing access to a huge selection of frames and lenses with 3-D virtual try-on technology. Please see the table below for a list of pricing for this voluntary pre-tax benefit. Dependent coverage is available to age 26.

For a complete list of in-network providers near you, visit eyemedvisioncare.com/bcbstx or call 1-855-556-8796. For LASIK providers, call 1-877-5LASER6

Vision Plan Biweekly Employee Cost

Monthly Employee Cost

Employee Only

$4.13 $7.84

$8.25 $15.67 $16.49 $24.25

Employee + Spouse

Employee + Child(ren) $8.25

Employee + Family

$12.13

Out-of-Network Reimbursement

Vision Care Service

In-Network Member Cost

FREQUENCY Examination

Once every 12 months Once every 12 months Once every 24 months

Lenses or contact lenses

Frame

Contact lens eval/fitting

N/A

VISION CARE SERVICES Exam with dilation as necessary Contact lens fit and follow up FRAMES Any available frame at provider location

$10 copay

Up to $30

Up to $40 for standard; 10% off retail price for premium

N/A

$0 Copay, $150 Allowance, 20% off balance over $150

Up to $75

STANDARD LENSES Single vision

$25 copay $25 copay $25copay $25 copay $90 copay

Up to $25 Up to $40 Up to $55 Up to $55 Up to $40 Up to $40

Bifocal Trifocal

Lenticular

Standard progressive lens Premium progressive lens LENS OPTIONS Tint (solid and gradient) Scratch resistant coating Polycarbonate lenses Ultraviolet coating Anti-reflective coating

See table on next page

$15

N/A

$0

Up to $5

$0 kids; $40 adults

Up to $5 KIDS

$15

N/A N/A N/A N/A N/A

See table on next page

High index lenses Polarized lenses

20% off retail 20% off retail

Photocromatic/transitions plastic

$75

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