| |
|
|
| Covered
Services |
Amount
Covered |
Frequency |
| Routine
Eye Exam |
Covered
100% (after $10 co-payment) |
Once
Every 12 Months |
| Frame |
Covered
100% (within plan allowance) |
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
 |
|
Avesis has hundreds of particpating
LASIK providers in Arizona.
|
| Rates |
|
| Employee
Only |
$6.34
per month |
| Employee + Family |
$17.18 per month |
| |
|
| |
|
| *Contact
lenses allowance takes the place of spectacle lenses and a frame for
that plan period. |
| |
|
|