Vision Benefits

Vision insurance offers coverage for the routine care of your eyes and may provide coverage for eyeglasses and contact lenses. Your plan will pay for these services based upon the schedule below. Be sure to check your plan certificate for details.

Keep in mind that your costs will generally be lower if you choose an in-network eye-doctor. To find an in-network eye-doctor, please visit https://eyedoclocator.eyemedvisioncare.com/paclife/en-us.

Eye Med Network	In-Network PLUS Provider	In-Network
Eye Exam	$0 Copay	$10 Copay
Lenses
Single	$25 Copay	$25 Copay
Bifocal	$25 Copay	$25 Copay
Trifocal	$25 Copay	$25 Copay
Lenticular	$25 Copay	$25 Copay
Progressive	$90 Copay	$90 Copay
Frames
Retail Allowance	$180 allowance + 20% off balance over $180	$130 allowance + 20% off balance over $180
Contact Lenses
Elective (in lieu of glasses)	$130 allowance	$130 allowance
Frequency of Services
Exam	Once every 12 months	Once every 12 months
Lenses	Once every 12 months	Once every 12 months
Frames	Once every 12 months	Once every 12 months
Contacts (in lieu of glasses)	Once every 12 months	Once every 12 months

	Per Pay Period Rate
Employee	$3.41
Employee + Spouse	$7.16
Employee + Child(ren)	$6.31
Family	$11.47

Downloads

Summary of Benefits

Provided By

Pacific Life

Provider Website

https://www.pacificlife.com/

Customer Service

855.810.3301