Vision Benefits

Eye Exam

$10 Copay

$10 Copay and Up to $45

   Standard & Premium

Up to $60 Copay

N/A

Prescription Glasses:

   Frames

$25 Copay then up to $130 Allowance

Costco Allowance Will be The Wholesale Equivalent

Up to $70

   Lenses

$25 Copay

$30 - $100

Contacts (instead of glasses, applies to materials only)

Up to $130 + 20% off Remaining Balance

Up to $105 Allowance

Frequency

Exam

Once every 12 months

Once every 12 months

Lenses

Once every 12 months

Once every 12 months

Frames

Once every 24 months

Once every 24 months

Contacts

Once every 12 months

Once every 12 months

Employee

$4.12

Employee + Spouse

$8.23

Employee + Child(ren)

$7.81

Family

$12.26