Eye Examination—$100

Benefits are provided once each calendar year for a complete analysis of the eyes and related structure to determine the presence of vision problems or other abnormalities. This exam must include refraction and must be performed by a licensed ophthalmologist (MD or DO) or optometrist (OD).

Prescription Lenses

Benefits are provided once each calendar year for one pair of lenses to improve visual acuity.

Single vision—$75
Bifocal—$105
Progressive—$150
Trifocal—$150
Lenticular—$150

Contact Lenses—$125

Benefits are provided once each calendar year for one pair of contact lenses when purchased in place of conventional lenses and frames. Benefits for disposable and/or replacement contact lenses are covered within the same annual maximum.

Special Lens Treatment—$40

Benefits are provided once each calendar year for certain features when such services are provided at an extra charge. These features include anti-reflective coating, tinting, oversized lenses, and scratch coating.

Frames—$90

Benefits are provided once each calendar year for eyeglass frames.