| Benefit |
Frequency |
In Network |
Out Of Network |
| Exam |
12 months |
$10 co-pay |
$10 co-pay; covered up to $35 |
| Lenses |
24 months |
$25 co-pay (you pay for specialty coatings and lenses, but receive a VSP discount) |
$25 co-pay; covered at $25 to $80 depending on type of lenses |
| Frames |
24 months |
$25 co-pay (you pay the extra amount for frames that cost more than the plan allowance) |
$25 co-pay; covered up to $45 |
| Contact Lenses |
24 months |
If medically necessary, 100% covered after $25 co-pay |
Covered up to $210 after $25 co-pay |
| Laser Vision Correction |
N/A |
Discounted Services |
No Coverage |