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Plan Highlights
AFvision TM
Select 130 Plan
Eye Examinations
- Once every 12 months
- $10 deductible
Standard Eye Glass Lens
- Once every 12 months
- $20 read deductible
Frames
- Once every 12 months
Contacts (in lieu of glasses)
- Once every 12 months
Allowance (Frame OR CL)
- $130
View Plan Details
STANDARD LENS OPTIONS
(cost of deductible)Single Vision Deductible | $20 |
Bifocal Vision Deductible | $20 |
Trifocal Vision Deductible | $20 |
Lenticular Deductible | $20 |
ADDITIONAL LENS OPTIONS AND COATINGS (SINGLE VISION ALLOWANCES)
(cost member will pay)UV Coating | $15 |
Tint | $15 |
Solid Plastic Dye | $15 |
Plastic GradGradient Dye | $15 |
Standard Scratch – Resistance | $15 |
Standard Polycarbonate Lenses | $40 |
Anti-Reflective Coating | $45 |
Photochromic Lenses – Plastic | Retail Discount |
Standard Progressive | $65 |
MAXIMUM ALLOWANCE
(for out-of-network)Exams | Up to $50 |
Frames | Up to $70 |
Single Vision | Up to $50 |
Bifocal Lenses | Up to $75 |
Progressive Lens | Up to $75 |
Trifocal Lenses | Up to $100 |
Lenticular | Up to $75 |
Elective Contact Lenses | Up to $105 |
**Medically Necessary Contact Lenses | Up to $250 |
Contact Lens Standard & Premium Fit and Follow Up | Up to $40 |
*Member Cost for Progressive lenses varies. The EyeMed doctor will be able to provide the patient with the exact amount they are responsible for.
**Medically necessary contact lens follows the contacts frequency; Medically necessary contacts are not available in TX.
STANDARD LENS OPTIONS
(cost of deductible)Single Vision Deductible | $20 |
Bifocal Vision Deductible | $20 |
Trifocal Vision Deductible | $20 |
Lenticular Deductible | $20 |
ADDITIONAL LENS OPTIONS AND COATINGS (SINGLE VISION ALLOWANCES)
(cost member will pay)UV Coating | $15 |
Tint | $15 |
Solid Plastic Dye | $15 |
Plastic GradGradient Dye | $15 |
Standard Scratch - Resistance | $15 |
Standard Polycarbonate Lenses | $40 |
Anti-Reflective Coating | $45 |
Photochromic Lenses - Plastic | Retail Discount |
Standard Progressive | $65 |
MAXIMUM ALLOWANCE
(for out-of-network)Exams | Up to $50 |
Frames | Up to $70 |
Single Vision | Up to $50 |
Bifocal Lenses | Up to $75 |
Progressive Lens | Up to $75 |
Trifocal Lenses | Up to $100 |
Lenticular | Up to $75 |
Elective Contact Lenses | Up to $105 |
**Medically Necessary Contact Lenses | Up to $250 |
Contact Lens Standard & Premium Fit and Follow Up | Up to $40 |
*Member Cost for Progressive lenses varies. The EyeMed doctor will be able to provide the patient with the exact amount they are responsible for.
**Medically necessary contact lens follows the contacts frequency; Medically necessary contacts are not available in TX.
- Rates and plan availability vary by state.
AFvision TM
Select 150 Plan
Eye Examinations
- Once every 12 months
- $10 deductible
Standard Eye Glass Lens
- Once every 12 months
- $20 read deductible
Frames
- Once every 12 months
Contacts (in lieu of glasses)
- Once every 12 months
Allowance (Frame OR CL)
- $150
View Plan Details
STANDARD LENS OPTIONS
(cost of deductible)Single Vision Deductible | $20 |
Bifocal Vision Deductible | $20 |
Trifocal Vision Deductible | $20 |
Lenticular Deductible | $20 |
ADDITIONAL LENS OPTIONS AND COATINGS (SINGLE VISION ALLOWANCES)
(cost member will pay)UV Coating | $15 |
Tint | $15 |
Solid Plastic Dye | $15 |
Plastic GradGradient Dye | $15 |
Standard Scratch – Resistance | $15 |
Standard Polycarbonate Lenses | $40 |
Anti-Reflective Coating | $45 |
Photochromic Lenses – Plastic | Retail Discount |
Standard Progressive | $65 |
MAXIMUM ALLOWANCE
(for out-of-network)Exams | Up to $50 |
Frames | Up to $70 |
Single Vision | Up to $50 |
Bifocal Lenses | Up to $75 |
Progressive Lens | Up to $75 |
Trifocal Lenses | Up to $100 |
Lenticular | Up to $75 |
Elective Contact Lenses | Up to $105 |
**Medically Necessary Contact Lenses | Up to $250 |
Contact Lens Standard & Premium Fit and Follow Up | Up to $40 |
*Member Cost for Progressive lenses varies. The EyeMed doctor will be able to provide the patient with the exact amount they are responsible for.
**Medically necessary contact lens follows the contacts frequency; Medically necessary contacts are not available in TX.
STANDARD LENS OPTIONS
(cost of deductible)Single Vision Deductible | $20 |
Bifocal Vision Deductible | $20 |
Trifocal Vision Deductible | $20 |
Lenticular Deductible | $20 |
ADDITIONAL LENS OPTIONS AND COATINGS (SINGLE VISION ALLOWANCES)
(cost member will pay)UV Coating | $15 |
Tint | $15 |
Solid Plastic Dye | $15 |
Plastic GradGradient Dye | $15 |
Standard Scratch - Resistance | $15 |
Standard Polycarbonate Lenses | $40 |
Anti-Reflective Coating | $45 |
Photochromic Lenses - Plastic | Retail Discount |
Standard Progressive | $65 |
MAXIMUM ALLOWANCE
(for out-of-network)Exams | Up to $50 |
Frames | Up to $70 |
Single Vision | Up to $50 |
Bifocal Lenses | Up to $75 |
Progressive Lens | Up to $75 |
Trifocal Lenses | Up to $100 |
Lenticular | Up to $75 |
Elective Contact Lenses | Up to $105 |
**Medically Necessary Contact Lenses | Up to $250 |
Contact Lens Standard & Premium Fit and Follow Up | Up to $40 |
*Member Cost for Progressive lenses varies. The EyeMed doctor will be able to provide the patient with the exact amount they are responsible for.
**Medically necessary contact lens follows the contacts frequency; Medically necessary contacts are not available in TX.
- Rates and plan availability vary by state.
AFvision TM
Choice 130 Plan
Eye Examinations
- Once every 12 months
- $15 deductible
Standard Eye Glass Lens
- Once every 12 months
- $25 read deductible
Frames
- Once every 12 months
- Deductible (material Deductible combined with lens)
Contacts (in lieu of glasses)
- Once every 12 months
Allowance (Frame OR CL)
- $130
View Plan Details
STANDARD LENS OPTIONS
(cost of deductible)Single Vision Deductible | $25 |
Bifocal Vision Deductible | $25 |
Trifocal Vision Deductible | $25 |
Lenticular Deductible | $25 |
ADDITIONAL LENS OPTIONS AND COATINGS (SINGLE VISION ALLOWANCES)
(cost member will pay)UV Protection Coating | $16 |
Glass Tints Solid and Dyes (Except Pink I & II) | $34 |
Solid Plastic Dye (Except Pink I & II) | $15 |
Plastic Gradient Dye | $17 |
Factory Applied Standard Scratch – Resistance Coating | $17 |
Polycarbonate Lenses | $31 |
Anti-Reflective Coating | $41 |
Photochromic Lenses – Plastic | $70 |
Standard Progressive* | N/A |
Other Add-On and Services | Discount |
MAXIMUM ALLOWANCE
(for out-of-network)Exams | Up to $45 |
Frames | Up to $70 |
Single Vision | Up to $30 |
Bifocal Lenses | Up to $50 |
Progressive Lens | Up to $50 |
Trifocal Lenses | Up to $65 |
Lenticular | Up to $100 |
Elective Contact Lenses | Up to $105 |
**Medically Necessary Contact Lenses | Up to $210 |
*Member Cost for Progressive lenses varies. The VSP doctor will be able to provide the patient with the exact amount they are responsible for.
**Medically necessary contact lens follows the contacts frequency; Medically necessary contacts are not available in TX.
STANDARD LENS OPTIONS
(cost of deductible)Single Vision Deductible | $25 |
Bifocal Vision Deductible | $25 |
Trifocal Vision Deductible | $25 |
Lenticular Deductible | $25 |
ADDITIONAL LENS OPTIONS AND COATINGS (SINGLE VISION ALLOWANCES)
(cost member will pay)UV Protection Coating | $16 |
Glass Tints Solid and Dyes (Except Pink I & II) | $34 |
Solid Plastic Dye (Except Pink I & II) | $15 |
Plastic Gradient Dye | $17 |
Factory Applied Standard Scratch - Resistance Coating | $17 |
Polycarbonate Lenses | $31 |
Anti-Reflective Coating | $41 |
Photochromic Lenses - Plastic | $70 |
Standard Progressive* | N/A |
Other Add-On and Services | Discount |
MAXIMUM ALLOWANCE
(for out-of-network)Exams | Up to $45 |
Frames | Up to $70 |
Single Vision | Up to $30 |
Bifocal Lenses | Up to $50 |
Progressive Lens | Up to $50 |
Trifocal Lenses | Up to $65 |
Lenticular | Up to $100 |
Elective Contact Lenses | Up to $105 |
**Medically Necessary Contact Lenses | Up to $210 |
*Member Cost for Progressive lenses varies. The VSP doctor will be able to provide the patient with the exact amount they are responsible for.
**Medically necessary contact lens follows the contacts frequency; Medically necessary contacts are not available in TX.
- Rates and plan availability vary by state.
AFvision TM
Choice 150 Plan
Eye Examinations
- Once every 12 months
- $15 deductible
Standard Eye Glass Lens
- Once every 12 months
- $25 read deductible
Frames
- Once every 12 months
- Deductible (material Deductible combined with lens)
Contacts (in lieu of glasses)
- Once every 12 months
Allowance (Frame OR CL)
- $150
View Plan Details
STANDARD LENS OPTIONS
(cost of deductible)Single Vision Deductible | $25 |
Bifocal Vision Deductible | $25 |
Trifocal Vision Deductible | $25 |
Lenticular Deductible | $25 |
ADDITIONAL LENS OPTIONS AND COATINGS (SINGLE VISION ALLOWANCES)
(cost member will pay)UV Protection Coating | $16 |
Glass Tints Solid and Dyes (Except Pink I & II) | $44 |
Solid Plastic Dye (Except Pink I & II) | $15 |
Plastic Gradient Dye | $17 |
Factory Applied Standard Scratch – Resistance Coating | $17 |
Polycarbonate Lenses | $35 |
Anti-Reflective Coating | $41 |
Photochromic Lenses – Plastic | $82 |
Standard Progressive* | Varies – See Note* |
Other Add-On and Services | Discount |
MAXIMUM ALLOWANCE
(for out-of-network)Exams | Up to $45 |
Frames | Up to $70 |
Single Vision | Up to $30 |
Bifocal Lenses | Up to $50 |
Progressive Lens | Up to $50 |
Trifocal Lenses | Up to $65 |
Lenticular | Up to $100 |
Elective Contact Lenses | Up to $105 |
**Medically Necessary Contact Lenses | Up to $210 |
*Member Cost for Progressive lenses varies. The VSP doctor will be able to provide the patient with the exact amount they are responsible for.
**Medically necessary contact lens follows the contacts frequency; Medically necessary contacts are not available in TX.
STANDARD LENS OPTIONS
(cost of deductible)Single Vision Deductible | $25 |
Bifocal Vision Deductible | $25 |
Trifocal Vision Deductible | $25 |
Lenticular Deductible | $25 |
ADDITIONAL LENS OPTIONS AND COATINGS (SINGLE VISION ALLOWANCES)
(cost member will pay)UV Protection Coating | $16 |
Glass Tints Solid and Dyes (Except Pink I & II) | $44 |
Solid Plastic Dye (Except Pink I & II) | $15 |
Plastic Gradient Dye | $17 |
Factory Applied Standard Scratch - Resistance Coating | $17 |
Polycarbonate Lenses | $35 |
Anti-Reflective Coating | $41 |
Photochromic Lenses - Plastic | $82 |
Standard Progressive* | Varies - See Note* |
Other Add-On and Services | Discount |
MAXIMUM ALLOWANCE
(for out-of-network)Exams | Up to $45 |
Frames | Up to $70 |
Single Vision | Up to $30 |
Bifocal Lenses | Up to $50 |
Progressive Lens | Up to $50 |
Trifocal Lenses | Up to $65 |
Lenticular | Up to $100 |
Elective Contact Lenses | Up to $105 |
**Medically Necessary Contact Lenses | Up to $210 |
*Member Cost for Progressive lenses varies. The VSP doctor will be able to provide the patient with the exact amount they are responsible for.
**Medically necessary contact lens follows the contacts frequency; Medically necessary contacts are not available in TX.
- Rates and plan availability vary by state.