Page 7 - Murphy Research 2020-21 Employee Benefits
P. 7
12/1/2020-11/30/2021 Employee Benefits Brochure
Vision Plan – Blue Shield
Your Copay/ Coinsurance In- Network Out-of-Network
Exam Copay
$15 $50 allowance
(once every 12 months)
Materials Copay $25 See below allowances
Lenses
(once every 12 months)
Single Covered in full after $25 $43 allowance
copay
Bifocal Covered in full after $25 $60 allowance
copay
Trifocal Covered in full after $25 $75 allowance
copay
Lenticular Covered in full after $25 $120 allowance
copay
Frames
(once every 12 months) $120 allowance $40 allowance
Contact Lenses
(once every 12 months)
Medically Necessary Covered in full after $25 $200 allowance
copay
Elective $120 allowance $120 allowance
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