Exam + Materials with DeltaVision IN-NETWORK OUT-OF-NETWORK Exam $10 copay Up to $45 reimbursement Glasses Lenses $25 copay Up to $65 reimbursement Glasses Frames $150 allowance Up to $70 reimbursement Necessary Contacts 100% covered Up to $210 reimbursement Elective Contacts $150 allowance Up to $105 reimbursement Each material benefit is paid out once per calendar year.