Review VISION Plan Summary Protect your sight and enjoy those sunsets even more with Vision vision insurance. Receive both preven琀椀ve and materials coverage. Hover over the insurance terms below to learn what they mean. VISION PLAN IN-NETWORK OUT-OF-NETWORK EXAMS $10 copay Up to $45 MATERIALS $25 copay $25 copay Single: Single: Up to $30 LENSES Bifocal: Bifocal: Up to $50 Trifocal: Trifocal: Up to $65 Len琀椀cular: Len琀椀cular: Up to $100 FRAMES $130 / 20% savings on amount over allowance Up to $70 CONTACT LENSES Elec琀椀ve: $130 Allowance Elec琀椀ve: Up to $105 Medically Necessary: Medically Necessary: Up to $210 Exams: 1 X 12 Months FREQUENCY Lenses: 1 X 12 Months OF SERVICES Frames: 1 X 12 Months Contact Lenses: 1 X 12 Months RATES PER Employee: $5.12 BIWEEKLY Employee + Spouse: $10.31 PAY PERIOD Employee + Children: $10.90 Family: $17.14 The bene昀椀ts and rates in this guide are for illustra琀椀ve purposes only. To the extent the rates or the bene昀椀t plan informa琀椀on summarized herein di昀昀ers from the underlying plan details speci- 昀椀ed in the insurance documents that govern the terms and condi琀椀ons of the plans of insurance described in this guide, the underlying insurance documents will govern in all cases.