PLAN OVERVIEW

• Vision Care Services: Comprehensive Routine Vision Exam $10 copay; Retinal imaging $39 copay; Standard Contact Lens Fitting $40 copay
• Frames: $140 allowance, plus a 20% discount off the balance. For example, a $200 frame would cost $48.
• Standard Plastic Lenses: Single Vision $25 copay; Bifocal $25 copay; Trifocal $25 copay; Progressive  $55-$200 copay
• Lens Options: Anti-Reflective Coating $45-$85 copay; Scratch Coating $15; Tint Coating $15; UV Coating $15
• Contact Lenses: Conventional covered up to $140 with a 15% discount off the balance; Disposable covered up to a $140 allowance; Medically needed $0 copay; Paid-Full