COVERAGE
|
IN-NETWORK BENEFITS
|
| COMPREHENSIVE EYE EXAMINATION |
U&C less 10% or $45, whichever
is less |
EYEGLASS LENSES
(added to the discounted EYEGLASS FRAME) |
Single $35
Bifocal (FT 28-35, round) $55
Trifocal (7x28, 8x35) $85
Lenticular U&C less |
EYEGLASS LENS OPTIONS
(added to the discount EYEGLASS FRAME) |
Ultra Violet Coating $12
Scratch Coating $12
Anti-Reflective Coating-Basic $36
Polycarbonate $30
Polarized-Single Vision $36
Polarized-Bifocal $54
All Other and Sunwear Accessories
U&C less 10% |
| EYEGLASS FRAMES |
U&C less 15% |
| CONTACT LENS EXAMINATION |
U&C less 10% or $85, whichever
is less |
CONTACT LENS
Conventional / Disposable |
U&C less 10% or 20% |
CONTACT LENS
Medically necessary |
U&C less 10% or 20% |
| CONTACT LENS FITTING FEE |
Included with Contact Lens Examination |
| LASER VISION CORRECTION (LASIK) |
Discount off U&C |
(Not an Insurance Product)
AEC.DMP.1000FS 04/07