Vision Plan Features

	IN NETWORK	OUT OF NETWORK
Covered Services Every 12 Months
Annual Exam	100%; no copay	$40 allowance
Frames	$200 allowance; 20% discount	$45 allowance
Lenses*
Single Vision	$20 copay	$25 allowance
Bifocal	$20 copay	$40 allowance
Trifocal	$20 copay	$55 allowance
Lenticular	$20 copay	$75 allowance
Contacts
Elective Conventional	$200 allowance; 15% discount	$105 allowance
Elective Disposable	$200 allowance	$105 allowance
Non-Elective	100%	$210 allowance
Contact Lens Fitting	100%	Not covered

_{* Options such as extra-thin lenses or special lens coatings may increase your out-of-pocket costs.}