In-Network Out-of-Network Exam $10 copay $42 allowance Glasses Lenses $10 copay $40 - $80 allowance (Single / Bifocal/ Trifocal) Glasses Frames $130 retail frame allowance $45 allowance + 20% off remaining balance Contact Lenses Covered in Full / $210 allowance / (Medically Necessary / Elective) $130 allowance $105 allowance Routine eye exams, glasses lenses, and contacts available once every 12 months. Frames available once every 24 months.