Vision Benefits

Vision Exam

$10 Copay

Up to $35

Frames

Frames Allowance

$150 Allowance
20% off balance over $150

Up to $75

Single

$25 copay

Up to $25

Bifocal

$25 copay

Up to $40

Trifocal

$25 copay

Up to $55

Lenticular

$25 copay

Up to $55

Contact Lenses

Elective

$150 allowance, 15% off
balance over $150

Up to $90

Medically Necessary

Fully Covered

Up to $200

Frequency

Vision Exam

Once every 12 months

Once every 12 months

Frames

Once every 12 months

Once every 12 months

Lenses

Once every 12 months

Once every 12 months

Employee

$3.08

Employee + Spouse

$5.73

Employee + Child(ren)

$6.74

Family

$8.68