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

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summary of benefits


*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.