Supplemental Vision Insurance Carrier

EyeMed Vision Care
Toll-Free Phone: (866) 939-3633

Policy or Group Number

Policy or Anniversary Date
July 01 – June 30

Employee Eligibility
Must be working 20 hours per week or more

Dependent Eligibility
Children under the age of 26

Waiting Period
(Time employee must wait before being eligible to enroll)
Date of hire

Initial Enrollment Period
(Time frame after the waiting period during which employee must enroll)
During active employment

Coverage Termination Date Upon Loss of Eligibility
The last day of the month in which you cease to meet eligibility requirements.

Premium Costs
100% Employee Paid


Coverage Level   Monthly Premium 
Subscriber   $6.22
Subscriber + Spouse   $11.81
Subscriber + Child(ren)   $12.44
Subscriber + Family   $18.28
EyeMed Vision Insurance Benefit Summary
EyeMed Vision Insurance Summary
EyeMed Member Web Guide
EyeMed Retail Provider List

For questions regarding Employee Benefits, contact:

Chris Steffen, Human Resources Coordinator
(952) 856-4513

Benefits Administration Contact:

PlanSource Benefits Administration: Tamara Knapp

Flexible Spending Accounts/HRA/VEBA Contacts:

Local Phone: (800) 859-2144

COBRA/Retiree Contact:

HR Simplified: Jamie Gould
(888) 318-7472 (Option 3 for COBRA, Option 4 for Retiree)
7:00 AM to 7:00 PM Monday-Thursday and 7:00 AM to 5:00 PM on Fridays