Benefits for 2024 Vision Coverage
SUMMARY OF COVERAGE
Benefit
In-Network
Out of Network
Frequency
Once every 12 months
EyeExam
$10Copay
Up to$25
Lenses -Single Vision -Bifocal -Trifocal/Lenticular
Up to $10 Up to $25 Up to$55
Once every 12 months
$25Copay
$130 allowance then 20% off
Once every 24 months
Frames
Up to$65
Contacts
$105 allowance then 15% off
Once every 12 months
Up to $75
-Elective
Up to$200
-Medically Necessary
Covered 100%
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.
2024 Employee Benefit Guide
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