Benefits for 2025 Vision Coverage
SUMMARY OF COVERAGE
In Network
Out-of-Network
Eye exam (once per calendar year)
$10 Copay
Up to $45 Reimbursement
Lenses (Single / Bifocal / Trifocal / Lenticular) (once per calendar year)
Covered in Full after $10 Copay
Up to ($32 / $55 / $65 / $80) Reimbursement
Frame allowance (once per calendar year)
$130 Allowance
Up to $71 Reimbursement
Elective Contacts (once per calendar year)
$130 Allowance
Up to $105 Reimbursement
Medically Necessary Contacts (once per calendar year)
Covered in Full
Up to $210 Reimbursement
Employee Cost
Vision Plan
Per Pay Period (26)
Employee
$3.50
Employee + 1
$7.30
Family
$10.52
This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.
2025 Employee Benefit Guide
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