Page 47 - Washington Nationals 2023 Benefits Guide -10.26.22_Neat
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SCHEDULE OF BENEFITS
OUTLINE OF COVERAGE
The Insurance for each Insured and each Insured Dependent will be based on the Insured's class shown in this
Schedule of Benefits.
Benefit Class Class Description
Class 1 All Eligiblie Employees
EYE CARE EXPENSE BENEFITS
When you select a Participating Provider, a discounted fee schedule is used which is intended to provide you, the
Insured, reduced out of pocket costs.
Deductible Amount:
Exams - Each Benefit Period $10
Contact Lens Fitting and Evaluation - Each Benefit Period $60
Frames and Lenses - Each Benefit Period $25
Please refer to the EYE CARE EXPENSE BENEFITS page for details regarding frequency, limitations, and
exclusions.
9040 DC Ed. 04-14
