IN NETWORK OUT-OF-NETWORK Exam $10 copay Reimbursement up to $45 Glasses Lenses $25 copay Reimbursement from $30-$65 Glasses Frames $130 Allowance Reimbursement up to $70 Contact Lenses Covered in Full / Reimbursement (Medically Necessary / Elective) $130 reimbursement up to $210 / $105 Each material benefit is paid out every 12 months, frames are every 24 months.