OPTICARE PLAN:
0-10-110C
Products/Services | Select Network | Broad Network | Out-Of-Network |
---|---|---|---|
Eye Exam | |||
Eyeglass exam | 100% Covered | $10 Co-pay | $40 Allowance |
Contact exam | 100% Covered | $10 Co-pay | $40 Allowance |
Routine Dilation | 100% Covered | Retail | Included above |
Contact Fitting | 100% Covered | Retail | Included above |
Standard Plastic Lenses | |||
Single Vision | 100% Covered | $10 Co-pay | $70 Allowance for lenses, options, and coatings |
Bifocal (FT 28) | 100% Covered | $10 Co-pay | $70 Allowance for lenses, options, and coatings |
Trifocal (FT 7x28) | 100% Covered | $10 Co-pay | $70 Allowance for lenses, options, and coatings |
Lens Options | |||
Progressive (Standard plastic no-line) | $10 Co-pay | $50 Co-pay | |
Premium Progressive Options | $80 Co-pay | $100 Co-pay | |
Polycarbonate | $20 Co-pay | $40 Co-pay | |
Anti-Reflective | $40 Co-pay | $45 Co-pay | |
High Index | $80 Co-pay | 25% Discount | |
Coatings | |||
Scratch Resistant Coating | 100% Covered | $10 Co-pay | |
Ultra Violet protection | 100% Covered | $10 Co-pay | |
Other Options | Up to 25% Discount | Up to 25% Discount | |
Edge polish, tints, mirrors, etc, | |||
Frames | |||
Allowance Based on Retail Pricing | $110 Allowance | $100 Allowance | $60 Allowance |
Additional Eyewear | |||
Additional Pairs of Glasses Throughout the Year | Up to 50% Off Retail | Up to 25% Off Retail | |
Contacts | |||
Contact benefits is in lieu of lens and frame benefit. | $110 Allowance | $100 Allowance | $80 Allowance |
Additional contact purchases: | |||
Conventional | Up to 20% off | Retail | |
Disposables | Up to 10% off | Retail | |
Frequency | |||
Exams, Lenses, Frames, Contacts | Every 12 months | Every 12 months | Every 12 months |
Refractive Surgery | |||
LASIK | 20% Off Retail | Not Covered | Not Covered |