Below is a summary of the vision plan. For complete details of the vision plan see the Summary of Benefits.
Covered Services
Exam
Frame
Spectacle Lenses
(Standard - Single Vision, Bifocal, Trifocal, Lenticular)
Contact Lenses*
LASIK
Rates
Employee Only
Employee + Spouse
Employee + Child(ren)
Employee + Family
Amount Covered
Covered 100% (after applicable $10 copay)
Covered 100% (within plan allowance and a $25 materials copay)
Covered 100%**
$130 Allowance
$150 one-time/lifetime allowance
$9.98 per month
$18.96 per month
$20.66 per month
$26.56 per month
Frequency
Once Every 12 Months
Once Every 12 Months
Once Every 12 Months
Once Every 12 Months
*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.