Benefit

Covered Services

Preferred

Non-Preferred

Exams
Age 19 & Under
Over Age 19

100% of Contracted Amount
One per 12 months
One per 24 months

70% of Contracted Amount
One per 12 months
One per 24 months

Frames/Paid (all ages)
Once every 24 months

100% of contracted amount

70% of allowance

Lenses
Age 19 and Under
Over Age 19

100% of contracted amount
One per 12 months
One per 24 months

100% of contracted amount
One per 12 months
One per 24 months

Contacts

     Medically Necessary

100% of contracted amount after cataract surgery

70% of amount after cataract surgery

     Cosmetic

Covered at single, bifocal, trifocal lens rate

Covered at single, bifocal, trifocal lens rate