Common use of Schedule of Vision Insurance Benefits Clause in Contracts

Schedule of Vision Insurance Benefits. (1) In-network provider benefits: Professional Services Examination co-pay $ 5.00 Materials Prescription glasses co-pay $ 12.50 • Includes single vision, bifocal, lenticular or trifocal lenses • Lens enhancements are an extra cost to member and not included in the co-pay. Retail frame allowance $135.00 Contact Lenses – necessary $195.00 Contact Lenses – cosmetic $115.00

Schedule of Vision Insurance Benefits. (1) In-network provider benefits: Professional Services Examination co-pay $ $5.00 Materials Prescription glasses co-pay $ $12.50 • Includes single vision, bifocal, lenticular or trifocal lenses • Lens enhancements are an extra cost to member and not included in the co-pay. Retail frame allowance $135.00 Contact Lenses – necessary $195.00 Contact Lenses – cosmetic $115.00135.00

Schedule of Vision Insurance Benefits. (1) In-network provider benefits: Professional Services Examination co-pay $ $5.00 Materials Prescription glasses co-pay $ $12.50 •  Includes single vision, bifocal, lenticular or trifocal lenses •  Lens enhancements are an extra cost to member and not included in the co-pay. Retail frame allowance $135.00 Contact Lenses – necessary $195.00 Contact Lenses – cosmetic $115.00135.00.