VISION BENEFITS SUMMARY |
Description | Co-pays |
EXAMINATION | |
Includes Tonometry | INCLUDED |
FRAMES | |
Up to $200 within GVS Collection | INCLUDED |
Non Covered Frame | U&C less $200 |
LENSES | |
Single Vision | INCLUDED |
Flat Top (FT28) | INCLUDED |
TriFocals | INCLUDED |
Standard Progressive | INCLUDED |
Oversize | INCLUDED |
Premium Progressive | $50.00 co-pay |
Deluxe Progressive | U&C less 35% |
MATERIALS | |
Plastic | INCLUDED |
Polycarbonate for children 16 and under included | U&C less 35% |
Polycarbonate | U&C less 35% |
COATINGS | |
Cosmetic or Sunglass Tint | INCLUDED |
Ultra Violet Coating | U&C less 35% |
Scratch Resistant Coating | U&C less 35% |
Anti-reflective Standard Coating | U&C less 35% |
Anti-reflective Premium Coating | U&C less 35% |
CONTACTS | |
Colored Contact Lenses are NOT included | |
Fitting and Dispensing Included for the following Lenses | INCLUDED |
Spherical Disposables- 12 months supply | INCLUDED |
Non Covered Contact Lenses | U&C less $200 |
Fitting Fee for Upgraded Lenses | $50.00 co-pay |
|
LENS BENEFITS CO-PAYS | |
MATERIALS/HI-INDEX LENSES | |
Hi-Index Single Vision | U&C less 35% |
PLASTIC PHOTOSENSITIVE LENSES | |
Plastic Photosensitive Single Vision | U&C less 35% |
Plastic Photosensitive Bifocal | U&C less 35% |
Polarized | U&C less 35% |