Vision Coverage

 

Adult routine vision exams (including refraction) performed by a legally qualified ophthalmologist or optometrist Includes fitting of prescription contact lenses

$30 copayment then the plan pays 100% (of the balance of the negotiated charge)per visit (In-network coverage)

$30 copayment then the plan pays 60% (of the balance of the recognized charge) per visit (Out -of-nework coverage)

Fitting of Contact maximum 1 visit

Eyeglass frames, prescription lenses or prescription contact lenses 80% (of the negotiated charge) per visit (In-network coverage)   60% (of the recognized charge) per visit (Out-of-network coverage)

Maximum per policy year - eyeglass frames and prescription lenses $150

Maximum per policy year - prescription contact lenses $75

Detailed information about the vision benefits can be found in the Plan Design and Benefits Summary on page 27.