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