Vision for 2021

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In-Network Coverage Out-of-Network Reimbursement
Annual Exam 100% covered $30
Spectacle Lenses 100% covered $25 for single vision lenses
$35 for bifocal lenses
$45 for trifocal lenses
$60 for lenticular (post cataract) lenses
Contact Lenses Disposables – 8 multi packs of lenses

Planned replacements - 4 multi packs of lenses
$225 for Medical Reason

$75 for Elective
Eyeglass Frame 100% (Certain Styles) Covered $130 allowance + 20% discount at Davis Visionworks

$75 allowance at any participating providers other than Visionworks
Warranty on Eyeglasses (not covered for loss) 100% covered None
Scratch-Resistant Protection 100% covered None
Laser Vision Correction Discounted None

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