Check benefit summary for additional lens options and costs Exam $0 copay Standard Glasses Lenses (Single / Bifocal/ Trifocal / Lenticular) $0 copay Glasses Frames $150 retail frame allowance OR $200 allowance at a PLUS Provider + 20% off remaining balance Contact Lenses (Medically Necessary / Elective) $0 copay / $25 copay with $200 retail allowance Vision Plan