Page 30 - 2019-2020 Country Financial Credit Union Benefit Booklet

Vision Coverage Overview

Plan 3 Covered Expenses

Benefit Frequency In-Network Member Out-of-Network Benefit
Cost

Exam Services 1 per 12 months $10 Up to $45
WellVision Exam®

Laser Vision Correction Once per eye per • Average 15% off N/A
Discount lifetime the regular price or
5% off the
promotional price
• Discounts only
available from
contracted facilities

Lenses 1 per 12 months $25 (lenses and
frame)
Single Lined Up to $30
Bifocal Lined Up to $50
Trifocal Up to $60
Lenticular Up to $100
Necessary Contacts Up to $210
Lens Enhancements N/A

Standard progressive $55 copay
Premium progressive $95-$105 copay
Custom progressive $150-$175 copay
Average savings of
20-25% on other lens
enhancements
Frames 1 per 24 months • $150 for the frame Up to $70
of your choice and
20% off the amount
over your allowance
$80 allowance at
Costco®*

Elective Contact Lenses 1 per 12 months • Up to $60/15% Up to $105
savings for your
contact lens exam
Contact lenses are in place
of lenses and frames (fitting and
evaluation)
• $150 for contact
lenses

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