| |
Basic Coverage
In-network Provider |
Plus Coverage
In-network Provider |
Out-of-Network Provider |
Eye Exam
Every 12 months |
You pay $10 |
You pay $10 |
Up to $45 allowance |
Frames
Basic - Every other calendar year
Plus - Every calendar year |
Up to $150 retail allowance/ $170 featured frame allowance.* $80 allowance at Costco Optical |
Up to $225 retail allowance/ $245 featured frame allowance.* $120 allowance at Costco Optical |
Up to $70 allowance |
Lenses
Every calendar year |
Single vision, bifocal, lined trifocal lenses covered in full |
Single vision, bifocal, lined trifocal lenses covered in full |
Single - Up to $30 allowance
Bifocal - Up to $50 allowance
Trifocal - Up to $65 allowance
|
Contact Lenses (if chosen in lieu of glasses)
Every 12 months |
Covered at 100% if medically necessary, up to $130 if elective |
Covered at 100% if medically necessary, up to $225 if elective |
Up to $210 allowance if medically necessary, up to $105 if elective |
Laser Vision Correction
Every 12 months |
Members receive a discount |
Members receive a discount |
Not available |