Gersh Vision Plan
For illustrative purposes only. Please refer to your plan documents for all plan details
In Network
Out-of-Network
Eye exam (1 per calendar year)
$10 Copay
Up to $45 reimbursement
Lenses (Single / Bifocal / Trifocal / Lenticular) (1 per calendar year)
Covered at 100% after $10 Copay
Up to ($32 / $55 / $65 / $80) reimbursement
Frame allowance (1 per calendar year)
$130 Allowance
Up to $71 reimbursement
Elective Contacts (1 per calendar year)
$130 Allowance
Up to $105 reimbursement
Medically Necessary Contacts (1 per calendar year)
Covered at 100%
Up to $210 reimbursement
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