basic vision

enhanced vision

 

In Network

Out of Network

In Network

Eye Exams
Once every calendar year

$10 Copay

Reimbursed up to $50

$15 Copay

Reimbursed up to $50

Single Vision Lenses
Once every calendar year

$20 Copay

Reimbursed up to $40

Covered in full

Reimbursed up to $40

Bifocal Lenses
Once every calendar year

$20 Copay

Reimbursed up to $60

Covered in full

Reimbursed up to $60

Trifocal Lenses
Once every calendar year

$20 Copay

Reimbursed up to $80

Covered in full

Reimbursed up to $80

Lenticular Lenses
Once every calendar year

$20 Copay

Reimbursed up to $80

Covered in full

Reimbursed up to $80

Frames
Once every calendar year

up to a $130 retail allowance

Reimbursed up to $90

up to a $130 frame allowance

Reimbursed up to $90

Contacts
Once every calendar year

Elective: $150 allowance

Elective: up to $105 max. reimbursement

Elective: $150 allowance

Elective: up to $105 max. reimbursement