Individual Plan B-1
Comprehensive Vision Insurance Plan |
Description of Benefits
After a $10 Co-Pay / AKA Annual Deductible |
 |
| Benefit | Frequency | Member Pays |
|
| Eye Examination | Every 12 Months | 100% Covered |
|
| Lenses | | |
|
| Single Vision | Every 12 Months | 100% Covered
up to plan limit |
|
| Bifocal | Every 12 Months | 100% Covered
up to plan limit |
|
| Trifocal | Every 12 Months | 100% Covered
up to plan limit |
|
| Lenticular | Every 12 Months | 100% Covered |
|
Tint #1
Any color, plastic lenses only | Every 12 Months | 100% Covered |
|
Frames*
($90.00 Frame Allowance)
* The employees will pay the additional charges if they select frames costing more than the plan allows | Every 24Months | 100% Covered
up to plan limit |
|
| Contact Lenses |
|
| Cosmetic Contact Lenses are available in addition to your basic benefit (see schedule of extras); or, if desired in lieu of all other services, $100 applies to the Doctor's Usual Customary Rate. |
|
| Medically Necessary Contact Lenses are available each 24 months as needed. This is a $250 benefit which includes: a special contact lens examination, follow up visits and Medically Necessary Lenses. |
|
| Many additional services are available at reduced fees on our schedule of extras. |
