Vision Plan
Standard lenses are covered.
AVESIS VISION OPTION In Network
Out of Network
Exam
$10 Copay
Reimbursed to $35
Frequency
Every 12 Months
Every 12 Months
Lenses
Covered 100%
Reimbursed to $25 to $80
Single/Bifocal/Trifocal/
after $10 copay
depending on lens
Frequency
Every 12 Months
Every 12 Months
Frames
$50 Wholesale Allowance up to $150 Retail Value
Reimbursed to $45
Frequency
Every 24 Months
Every 24 Months
Contact Lenses
Medically Necessary
Medically Necessary
(In lieu of frames
Covered in Full
Reimbursed to $250
and lenses)
Elective
Elective
$130 Allowance
Reimbursed to $130
Every 12 Months
Every 12 Months
Lenticular
Frequency
11
