Vision

Advantage Enhanced Benefit Frequency & Plan Design
Examination Lenses Frame Contacts
Eligible 12 months 12 months 24 months 12 months

Advantage Enhanced Schedule of Benefits
In-Network Out-of-Network
Eye Examiniation Covered in full if eligible by date Reimbursed up to $35.00

Spectacle Lenses (pair)

Standard Single Vision Covered in full if eligible by date Reimbursed up to $25.00
Standard Bifocal Covered in full if eligible by date Reimbursed up to $40.00
Standard Trifocal Covered in full if eligible by date Reimbursed up to $50.00
Standard Lenticular Covered in full if eligible by date Reimbursed up to $80.00
Progressive 20% off U/C*
minus $50 allowance
if eligible by date Reimbursed up to $40.00
Specialty Lenses (pair) 20% off U/C*
minus the corresponding
standard lens plan payment
if eligible by date Corresponding standard
lens reimbursement
Lens Options Preferred Pricing Reimbursed up to $0.00
Frames $35 wholesale allowance Reimbursed up to $45.00

Contact Lenses
(in lieu of frame and spectacle lenses)

Elective $110 allowance after
20% discount if eligible by date Reimbursed up to $110.00
Medically Necessary Covered in full if eligible by date Reimbursed up to $250.00