EYEGLASSES $15 co-pay applies
Materials	Participating Coverage Allowance
*Lenses, one pair per 12 months Single vision lenses Lined bifocal lenses Lined trifocal lenses Progressive Addition lenses **Frames, one pair per 24 months	Pays 100% Pays up to cost of lined trifocal lenses Pays 100% up to Plan Allowance
*Optional lens enhancements which exceed the Plan Limit and which may be purchased by the patient include: tinted, high index, ultraviolet coating or scratch coating. **Price of frames varies by provider. Plan Limit frame price is typically between $90.00 and $120.00. Patient may pay the difference in cost for a frame which exceeds the Plan Limit.
CONTACT LENSES No co-pay required
Materials	Participating Coverage Allowance
Once per 12 months in lieu of lenses and/or frames. All types of contact lenses are covered including disposable, rigid, gas permeable and soft.
Visually necessary Medically necessary (for Keratoconus and Aphakia)	$105 $165
COSMETIC SURGERY AND COSMETIC WRINKLE REMOVAL
Service	Participating Coverage Allowance
Cosmetic Eye Surgery Cosmetic Wrinkle Removal	20% Discount 20% Discount