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