VISION

	Coverage Includes
Routine Eye Exam	100%
Frequency	Every 12 months
Eyeglass Frames	Up to $170
Frequency	Every 24 months
Eyeglass Lenses	Single Vision – Up to $75 Bifocal Lenses – Up to $100 Trifocal Lenses – Up to $125
Frequency	Every 12 months
Contact Lenses	You have the option of contacts OR frames/lenses per calendar year.
Frequency	Every 12 months
Elective Conventional	Up to $150
Frequency	Every 12 months
Elective Disposable	Up to $150
Frequency	Every 12 months
Non-elective (medically necessary)	Up to $400
Frequency	Every 12 months

Employee Level	Monthly
Single	$20.92
Family	$52.20

Resources

Schedule of Benefits

Dependents

Dependents can be covered until the end of the month in which they reach age 26. A dependent is not required to be a student; they can be married or have a job that offers insurance. If the dependent is your child, that dependent can remain covered to the age of 26.

Network

Under this vision plan, you do not need to choose a vision care provider from a network. You can go to any provider you choose.