10 VISION Protect your sight and enjoy those sunsets even more with vision insurance. Receive both preventive and materials coverage. Hover over the insurance terms below to learn what they mean. EXAMS $20 Copay $45 Exam Allowance MATERIALS $20 Copay N/A LENSES Single: Covered after Copay Bifocal: Covered after Copay Trifocal: Covered after Copay Single: $30 Allowance Bifocal: $50 Allowance Trifocal: $65 Allowance FRAMES $130 Allowance $70 Allowance CONTACT LENSES (in lieu of glasses & frames) Elective: $130 Allowance Elective: $105 Allowance FREQUENCY OF SERVICES Exams: 1 X 12 Months Lenses: 1 X 12 Months Frames: 1 X 24 Months Contact Lenses: 1 X 12 Months FIRM MONTHLY PREMIUM Employee: $7.22 Employee + Spouse: $7.22 Employee + Family: $11.80 EMPLOYEE MONTHLY PREMIUM Employee: $0 Employee + Spouse: $4.00 Employee + Family: $8.00 VISION PLAN The benefits and rates in this guide are for illustrative purposes only. To the extent the rates or the benefit plan information summarized herein differs from the underlying plan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this guide, the underlying insurance documents will govern in all cases. Vision Review Plan Summary In-Network Out-of-Network