VISION CARE SERVICES (Once per calendar year)
Comprehensive Routine Vision Exam $10 copay | Retinal imaging $39 copay | Standard Contact Lens Fitting $40
FRAMES (Once per calendar year)
$140 allowance, plus a 20% discount off balance
For example, a $200 frame would cost $48
STANDARD PLASTIC LENSES (Once per calendar year)
Single Vision $25 copay | Bifocal $25 copay | Trifocal $2S copay | Progressive $25-$20O copay
LENS OPTIONS
Anti-Reflective Coating $45-$80 copay | Scratch Coating $15 | Tint Coating $15 | UV Coating $15
CONTACT LENSES (Once per calendar year, in lieu of spectacle lenses)
Conventional covered up to $140 with a 15% discount off the balance
Disposable covered up to a $140 allowance
Medically Necessary $0 copay; Paid-Full