Page 9 - 2021 HN Benefits Booklet

VISION INSURANCE

Health Net
Group Number: 1234567
Plan: Preferred 1025-2

Copayments In-Network Benefit

Exams: $10 copay
Materials/Frames: $100 allowance

Frequency

Exams: Every 12 months

Lenses: Every 12 months
Frame: Every 24 months

Allowances In Network

Exams: $10 copay
Lenses: $25 copay
Single vision lenses: $25 copay
Bifocals: $25 copay
Trifocals $25 copay
Frames: $100 allowance
Contact Lenses $90 allowance

Questions?

Member Services: 888-926-4988
Website: www.healthnet.com

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