Vision

BENEFITSIN-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).
COINSURANCEPercentage of BCBSM’s approved amount

2024 Blue Vision VSP Benefits-at-a-Glance Summary