| Plan Features |
In-Network |
Out-of-Network |
|
Frequency of Service
- Exams
- Lenses/Contacts
- Frames
|
- Once every calendar year
- Once every calendar year
- Once every other calendar year
|
- Once every calendar year
- Once every calendar year
- Once every other calendar year
|
|
Exams
Frames
Lenses
- Single Vision
- Bifocal
- Trifocal
|
No copay
No copay (up to $130 retail), then 20% off any remaining balance
- $10 copay
- $10 copay
- $10 copay
|
Up to a maximum allowance of $35
Up to a maximum allowance of $45
- Up to a maximum allowance of $25
- Up to a maximum allowance of $40
- Up to a maximum allowance of $55
|
|
Contacts (in lieu of prescription eyeglass lenses)
|
Up to a maximum allowance of $130. This benefit applies to one order of contact lenses per calendar year
|
Up to a maximum allowance of $105. This benefit applies to one order of contact lenses per calendar year
|