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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
summary of benefits

 

Rates  
Employee Only $9.98 per month
Employee + Spouse $18.96 per month
Employee + Child(ren) $20.66 per month
Employee + Family $26.56 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.
     

Contact Information:
Call 1-800-828-9341

 

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