VISION PLAN
SUMMARY OF COVERAGE
Vision Benefit
In Network
Frequency
Eye Exam
$10 copay
Once every 12 months
Lenses Single Bifocal Trifocal
$25 Copay
Once every 12 months
Frames
Plan pays up to $150
Once every 24 months
Contacts
Elective
Plan pays up to $150
Once every 12 months
Medically Necessary
Covered in full after $25 Copay
Vision Costs included in Meritain Medical Costs
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CAMPBELL & COMPANY BENEFITS GUIDE
VISION PLAN I
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* For illustrative purposes only. Please refer to your plan documents for all plan details
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