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 + Family

Amount Covered

Covered 100% (after applicable $10 copay)

Covered 100% (within plan allowance)


Covered 100%**

$130 Allowance

$150 one-time/lifetime allowance

$10.43 per month
$24.50 per month

Frequency

Once Every 12 Months

Once Every 12 Months


Once Every 12 Months

Once Every 12 Months

Click here to view your
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.