Materials copay is $10 applied to lenses and frames. Exams, Lenses, contacts are paid out every calendar year. Frames are paid out every 24 months. Exam $10 copay $42 allowance Glasses Lenses (Single / Bifocal/ Trifocal) $0 copay $40 allowance $60 allowance $80 allowance Glasses Frames $10 copay $140 allowance 20% discount on remaining $45 allowance Contact Lenses (Medically Necessary / Elective) Covered in full / $120 allowance $210 allowance / $105 allowance IN NETWORK OUT-OF-NETWORK

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