Benefits Overview
Vision Benefits Chart
BENEFITS | IN-NETWORK COVERAGE |
---|---|
EYE EXAM | $5 copay (once every 12 months) |
LENSES | one pair of lenses, with or without frames, in any period of 12 consecutive months |
STANDARD LENSES | $10 copay (one copay applies to both lenses and frames) |
STANDARD FRAMES | $130 allowance, less $10 copay, one frame in any period of 12 consecutive months) |
CONTACT LENSES (contact lenses up to the allowance in any period of 12 consecutive months Medically Necessary | $10 copay |
Elective Contact Lenses (prescribed, but not medically necessary) | $130 allowance applied toward contact lens exam (fitting and materials) and the contact lenses (member responsible for any cost exceeding the allowance). |
COINSURANCE | Percentage of BCBSM’s approved amount |