Vision Plan
Healthy eyes and clear vision are an important part of your overall health and quality of life. You may enroll yourself and your eligible dependents or you may waive vision coverage. You do not have to be enrolled in medical coverage to elect vision coverage or cover the same dependents under medical and vision.
Although vision care services and supplies are covered in-network and out-of-network, your benefits are generally greater when you use in-network providers. Your costs are based on the family members you choose to cover.
| In-Network | Out-Of-Network | |||
|---|---|---|---|---|
| Examination | ||||
| Benefit | $20 copay | Reimbursement amounts apply | ||
| Frequency | 12 months | 12 months | ||
| Materials | $20 copay | Allowance applies (see exact amounts below) | ||
| Eyeglass Lenses | ||||
| Single Vision Lens | No charge after applicable copay | Reimbursed up to $30 allowance | ||
| BifocaI Lens | No charge after applicable copay | Reimbursed up to $50 allowance | ||
| Trifocal Lens | No charge after applicable copay | Reimbursed up to $65 allowance | ||
| Frequency | 12 months | 12 months | ||
| Frames | ||||
| Benefit | Coverage limited to $130 plan allowance | Reimbursed up to $70 | ||
| Frequency | 24 months | 24 months | ||
| Contacts (Elective) | ||||
| Benefit | Coverage limited to $130 in lieu of glasses and frames | Reimbursed up to $105 allowance | ||
| Frequency | 12 months | 12 months | ||