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2021 vision plan comparison

BasicHigh
Routine Eye Exam

In-network: Plan pays 100%

Out-of-network: Plan pays up to $19

In-network: Plan pays 100%

Out-of-network: Plan pays up to $19

Lenses

In-network: $40 copay (includes single, biofocal, trifocal and scratch resistant; polycarbonate lenses are included for dependent children); available every other calendar year

Out-of-network: Limited scheduled amount on vision, lined bifocal and trifocal lenses

In-network: $10 copay (includes single, biofocal, trifocal, progressive, scratch resistant, UV coating and anti-reflective; polycarbonate lenses are included for dependent children); available once per calendar year

Out-of-network: Limited scheduled amount on single vision, lined biofocal and trifocal lenses

Frames

In-network: Plan pays up to $130 with 20% discount if price exceeds maxiumum; available every other calendar year

Out-of-network: Plan pays up to $22

In-network: Plan pays up to $155 with 20% discount if price exceeds maxiumum; available once per calendar year

Out-of-network: Plan pays up to $22

Contact Lenses

In-network: $40 copay for contact lenses exam; plan pays up to $130 for contact lenses; available every other calendar year

Out-of-network: Plan pays up to $130

In-network: $10 copay for contact lenses exam; plan pays up to $155 for contact lenses; available once per calendar year

Out-of-network: Plan pays up to $130

Computer Vision Care

NONE

$10 copay for lenses every calendar year. Plan pays up to $90 for frames; available every other calendar year

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