Vision Benefits
In-Network |
Out-of-Network |
Frequency |
|
|---|---|---|---|
Exam / Materials Copay |
$10 Copay |
$10 Copay |
Once every calendar year |
Lenses: |
Materials Copay |
Up to $30 |
Once every calendar year |
Frames |
$150 Allowance |
Up to $70 |
Once every calendar year |
Contact Lenses (in lieu of glasses) |
$150 |
Up to $105 |
Per Pay Period Rates (48 Pay Periods) |
|
|---|---|
Employee |
$1.99 |
Employee + Spouse |
$3.98 |
Employee + Child(ren) |
$3.50 |
Family |
$5.49 |
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