| Benefits |
| Annual Eye Exam |
| Frequency (based on date of Plan Year) | Once every 12 months |
| Eye Exam Reimbursement | Up to $40 |
| Materials Copay |
| Applies to either Frame or Lenses | $25 |
| Eye Glass Frames |
| Frequency (based on Plan Year) | Once every 24 months |
| Selection of over 2000 Frames | $200 Allowance |
| Designer Brands | $100 Allowance |
| Eye Glass Standard Lenses |
| Frequency (based on Plan Year) | Once every 24 months |
| Single Vision | Covered in Full |
| Bifocal | Covered in Full |
| Lens Upgrades | Member Cost |
| Polycarbonate Lenses | $25 |
| Ultra & Premier Progressive Lenses | $50 |
| Blue light (Digital block) protection | 50% off |
| Sunglasses tint | 50% off |
| Photochromic lenses | 50% off |
| Premium thin lenses (hi-index) | 25% off |
| Contact Lenses (in lieu of glasses) |
| Frequency (based on Plan Year) | Once every 24 months |
| Contact Lenses | $100 Allowance |
| Additional Information |
| • $200 Allowance provide a covered-in-full free frame from a huge selection of over 2000 frames. |
| • Contact lenses benefit in lieu of glasses. |
| • One pair of covered glasses per member every year. Additional pair of discounted eyeglasses or
sunglasses - 25-50% off. |
