VISION PLANS
SUMMARY OF COVERAGE
Benefits
Reimbursement Plan*
Vision Exam
$15 Copay**
Lenses (Single/Bifocal/Trifocal)
$30 Copay**
Frames
$130 Allowance after $30 Copay
Non-Sectional Contacts
Up to $105 Allowance
Medically Necessary Contacts
$30 Copay
Benefit Frequency (Exams/Lenses/Frames)
12/12/24
*Benefit is only available if member elects Medical Coverage. This benefit is not automatic and requires member election.
**Members pay upfront to the vision provider, submit the claim and wait for reimbursement from Meritain. In addition, these services are subject to Reasonable and Customary limits
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MOTHER BENEFITS GUIDE
VISION PLAN I
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