Page 5 - Identity MSO 2021 Employee Benefits - Semi Monthly
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Identity MSO
2021 Employee Benefits Brochure
NEW! Blue Shield Vision Plan
In- Network Out-of-Network
Exam
(once every 12 months) Covered in full Up to $50
Lenses (once every 12 months)
Single, Bifocal, Trifocal Covered in full after $25 copay Up to $43 / $60 / $75 / $120
Frames
(once every 12 months) $130 allowance then 20% off Up to $40
remaining balance
Contact Lenses – elective disposable
(once every 12 months ) $120 allowance Up to $120
Contact Lenses – non-elective Covered in full Up to $250
(once every 12 months )
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