Introduction

Vision benefits are paid based on the Table of Covered Vision Care below. This table lists the vision services and supplies covered and the maximum amount paid for each service or supply. These services and supplies are available once each calendar year. If expenses  exceed Table of Covered Vision Care maximums, this plan will not pay the additional costs. If your vision care provider charges more than this maximum amount, you are responsible for the difference. Vision benefits are not subject to the $200 annual deductible or the $2,300 annual coinsurance maximum.