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What the Plan Provides

For the following exams, each covered individual is limited to one service per calendar year.
Care and Service
In-Network Cost
Non-Network Reimbursement
WellVision Exam®
A complete initial vision analysis, which includes a comprehensive visual exam, including the prescription for corrective eyewear and dilation, if necessary
$0 copayment
Reimbursed up to $45
Retinal Imaging Screening
An enhancement to the WellVision Exam®.
Up to $39 copayment
No coverage
Standard Contact Lens Fit & Follow-Up Exam*
Fitting and evaluation
Copayment of up to $40
No coverage
Premium Contact Lens Fit & Follow-Up*
Copayment of up to $55
No coverage
* One Contact Fit/Follow-Up benefit per calendar year (either standard or premium).