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| Below is a summary of the vision plan. For complete details of the vision plan see the Summary of Benefits. | ||
| Covered Services | Amount Covered | Frequency |
| Exam | Covered 100% (after applicable $10 copay) | Once Every 12 Months |
| Frame | Covered
100% (within plan allowance and a $25 materials copay) |
Once Every 12 Months |
| Spectacle
Lenses (Standard - Single Vision, Bifocal, Trifocal, Lenticular) |
Covered 100%** | Once Every 12 Months |
| Contact Lenses* | $130 Allowance | Once Every 12 Months |
| LASIK | $150 one-time/lifetime allowance | Click
here to view your |
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| Rates | ||
| Employee Only | $8.50 per month | |
| Employee + Spouse | $16.06 per month | |
| Employee + Child(ren) | $17.50 per month | |
| Employee + Family | $22.50 per month | |
| *Contact
lenses allowance takes the place of spectacle lenses and a frame for
that plan period. ** Covered in full after the material copay is met. |
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