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Vision Care 150
Option 1
Option 2
Funding type
Employer paid & voluntary
Employer paid & voluntary
Copayments
Eye examination Spectacle lenses
Eye examination1
Spectacle lenses
Frame
Contact lens evaluation, fitting & follow-up care
Contact lenses (in lieu of eyeglasses)
$10 $25
12 months 12 months 24 months
12 months 12 months
• Fully covered or minimal copay for Davis Vision Exclusive Collection of frames,2 or • $150 frame allowance, plus 20% off the overage at in-network providers, or
• $200 frame allowance at Visionworks
$0
Frequency
$0
12 months
12 months
12 months
12 months
12 months
Frame allowance options
Fully covered lens options
• Clear plastic single-vision, lined bifocal, trifocal, or lenticular lenses (any prescription)
• Ultraviolet coating
• Scratch-resistant coating
• Oversize lenses
• Polycarbonate lenses3, 5
• Tinting of plastic lenses4
• Standard progressive lenses5
Need vision coverage?
If you choose DPOS or POS medical plans, routine eye exams are included, and you can choose to enhance your benefit with a plan that includes frames and lenses. If you offer PPO medical plans, you can choose any one of our vision plans for complete coverage.
1. Inclusive of dilation when professionally indicated.
2. Allowances are up to the amount shown for each plan type.
3. Polycarbonate lenses are covered in full for dependent children, monocular patients, and patients with prescriptions +/- 6.00 diopters or greater. 4. Vision Care 130 and Vision Care 150 only.
5. Vision Care 150 only.
2023 Large Group Plans | Independence Blue Cross 56