 |
Optional
Vision Benefits |
Services
and Benefit options |
Lifetime
deductible |
$50 |
Lenses
& Contact Limit Per Calendar year |
One
Pair |
Frames
Limit Per Calendar year |
One
Pair |
Maximum
Allowances |
|
Examinations
|
|
Vision
analysis by an M.D. |
$75.00 |
Vision
analysis by an O.D. |
$60.00 |
Lenses |
|
Single
Vision Lens |
$18.75 |
Single
Vision Lenses |
$37.50 |
Bifocal
Lens |
$35.00 |
Bifocal
Lenses |
$70.00 |
Trifocal
Lens |
$45.00 |
Trifocal
Lenses |
$90.00 |
Lenticular
Lens |
$56.25 |
Lenticular
Lenses |
$112.50 |
One
Contact Lens |
$25.00 |
Two
Contact Lenses |
$50.00 |
Frames |
$50.00 |