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 $10 materials copay)
Covered 100%**
$110 Allowance
$100 one-time/lifetime allowance
$8.43 per month
$14.74 per month
$17.72 per month
$21.56 per month
Frequency
Once Every 12 Months
Once Every 24 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.