IN NETWORK OUT-OF-NETWORK Routine Exam $10 copay $45 allowance $30 allowance single vision Lenses $25 copay $50 allowance Bifocal $65 allowance Trifocal Frames $130 allowance $70 allowance Elective Contacts $130 allowance $105 allowance Necessary Contacts 100% covered $210 allowance Each material benefit is paid out once every 12 months, frames every 24 months.