Vision Plan 1
Benefit Co-Payments Examinations . . . . . . . . . . . . . . . . . . . . . $15.00 Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $25.00 In-Network Benefits Exam: A complete vision examination by a participating optometrist or ophthalmologist every 12 months with a $15 co-pay each year. Lenses: If prescribed, a pair of single vision or standard lined multi-focal lenses every 12 months with a $25 co-pay each year. Contact Lenses: After a $25 co-pay each year, contact lense benefit covers in full the fitting / evaluation fees, contacts (disposable contacts / up to 4 boxes, depending on the prescription and plan selected), and up to two follow up visits. A $105 allowance is applied toward the fitting / evaluation fees and purchase of contact lenses outside of covered-in-full contacts (materials co-pay does not apply). Toric, gas permeable, and bifocal contacts are all examples of contacts that are outside of our covered-in-full selection. Any amount over the allowance is the patient’s responsibility. Frames: Your choice from a wide selection of fashionable frames will be covered-in-full every 24 months. The materials co-pay is a single payment that applies to the entire purchase of eyeglasses (lenses and frames), or contacts in lieu of eyeglasses. If you select a frame from outside the covered selection, you will be given a minimum $130 frame allowance for frames purchased at retail chain providers. Patient Options: Should you select items not covered by the program, such as: progressive lenses, tints, coatings, etc., there will be an additional charge. These charges, however, are below usual retail costs. (Standard Scratch coating is covered in full at no cost to the insured). Monthly Premium Individual Rates Two Year Rate Guarantee. Available to Individuals by: Monthly bank draft or credit card
| ||||||||||||||
