Vision Coverage for Pre-65 Retirees
Aetna Vision PreferredSM is administered by EyeMed Vision Care and is automatically included with the Aetna Choice POS II Plan. Important note: Although your vision coverage is bundled with medical, your network of providers are different. You can locate a provider in the Aetna Vision Preferred Network at www.aetnavision.com.
SUMMARY OF PLAN AND COVERAGE
The following table shows the Aetna Choice POS II Plan details.
| Plan Features |
In-Network Services |
Out-of-Network Services |
| Exam with Dilation as Necessary (once every calendar year) |
$25 copay |
$50 |
| Exam Options – |
|
|
| Standard Contact Lens Fit and Follow-Up |
Up to $55 |
N/A |
| Premium Contact Lens Fit and Follow-Up |
10% off retail price |
N/A |
| Frames: Any Available Frame at Provider Location (once every two calendar years) |
$0 copay; $150 allowance; 20% off balance over $150 |
$70 |
| Standard Plastic Lenses (once every two calendar years) |
|
|
| – Single Vision |
$25 copay |
$50 |
| – Bifocal |
$25 copay |
$75 |
| – Trifocal |
$25 copay |
$100 |
| – Lenticular |
$25 copay |
$100 |
| Contact Lenses (Contact lenses allowance includes materials only. Once every calendar year) |
|
|
| – Conventional |
$0 copay; $150 allowance, 15% off balance over $150 |
$105 |
| – Disposable |
$0 copay; $100 allowance, plus balance over $150 |
$105 |
| – Medically Necessary |
$0 copay; Paid-in-full |
$210 |
| Laser Vision Correction |
15% off retail price or 5% off promotional price |
N/A |
