Using Out-of-Network Providers
If you receive services from an Out-of-Network (OON) provider, you will pay for the full cost at the point of service. You will be reimbursed up to the maximums as outlined in the Benefit Summary section. To receive your Out-of-Network reimbursement, complete and sign an Out-of-Network claim form, attach your itemized receipts and send to:
EyeMed Vision Care
Attn: OON Claims P.O. Box 8504
Mason, OH 45040-7111
REMINDER
You will recieve the maximum benefit by using In-Network providers.
NOTE
For your convenience, an EyeMed Out-of-Network claim form is available at
www.eyemedvisioncare.com or by calling EyeMed’s Customer Care Center at
1-866-723-0513.
If you elect to use Out-of-Network providers, you will be responsible for paying the Out-of-Network provider in full at the time of service. You may then submit an Out-of-Network claim form for reimbursement. You will be reimbursed up to the amount shown on the Benefit Summary chart.
For prescription contact lenses for only one eye, the Vision Care Plan will pay one-half of the amount payable for contact lenses for both eyes.
Unused benefit allowances for a particular service cannot be used for part of an additional service within the same calendar year.
