EligibilityEnrolling in BenefitsMaking Changes During the YearSelecting a Medical PlanHealth ProsContact a Benefits Provider
Plan Summary
Download (PDF)

What You Pay in the Vision Plan

In-network Provider Out-of-network Provider
Routine Eye Exam
Every calendar year
$10 copay $50 allowance
Every other calendar year; if lenses and frames are purchased together, the combined copay is $25
$25 copay
$230 frame allowance;
20% savings on the amount over your allowance
$70 allowance per two years
Standard Lenses
Single vision, lined bifocal, lined trifocal; polycarbonate
Every calendar year
$25 copay Single: $50
Bifocal: $75
Trifocal: $100
(allowance per year)
Contacts - Medically Necessary
Every calendar year
$25 copay $300 allowance per year
Contacts - Cosmetic
Every calendar year
$180 allowance per year applied to contact lenses and contact lens exam (fitting and evaluation) $120 allowance per year
Discounts: Visit to learn about discounts on laser vision correction and soft contact lenses.