Limitations, exclusions, restrictions and reductions Limitations In no event will coverage exceed the lesser of: • the actual cost of the examination or materials, or • the limits of coverage shown in the Vision benefit details. The allowance for lenses shown in the Vision benefit details is for two lenses. If only one lens is needed, coverage will be 50% of the allowance shown for two lenses. Benefits will not be payable for replacement of lost or broken materials until the next eligible benefit period. The plan is designed to cover visually necessary materials rather than cosmetic materials. When you or a covered dependent select any of the following extras, the plan will pay the basic cost of the allowed lenses, and you or the covered dependent will pay the additional costs for the options. • Optional cosmetic processes • Anti-reflective coating • Color coating • Mirror coating • Scratch coating • Blended lenses • Cosmetic lenses • Laminated lenses • Oversize lenses • Progressive multifocal lenses • Photochromic lenses; tinted lenses except Pink #1 and Pink #2 • UV (ultraviolet) protected lenses • Certain limitations may apply to low vision care benefits • A frame that costs more than the plan allowance • Contact lenses (except as noted in the Vision benefit details) General Exclusions Covered vision expenses do not include, and we will not pay benefits for, the following: • Orthoptic or vision training and any associated supplemental testing • Plano lenses • Two or more pairs of glasses (lenses and frames), in lieu of bifocals or trifocals • Medical or surgical treatment of the eye, eyes, or supporting structures, except for laser surgery as shown under the Vision benefit details • Materials, services or options not shown in the Vision benefit details • Treatment or materials of an experimental nature State variations can exist; please contact Sun Life Financial for additional information.
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