Aetna Vision Plan
Benefits
In-Network
Out-of-Network
$10 Copay
Up to $25
Eye Exam
$25 Copay
Up to $10
Single Vision Lenses
$25 Copay
Up to $25
Bifocal Lenses
$25 Copay
Up to $55
Trifocal Lenses
$25 Copay
Up to $55
Lenticular Lenses
$130 allowance then 20% off
Up to $65
Frames
$105 allowance then 15% off
Up to $75
Contact Lenses Elective
Contact Lenses Medically Necessary
Covered 100%
Up to $200
Frequency is 1per calendar year for exams, lenses, contact lenses, and 1per 2 calendar years for frames.
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