Page 15 - SBCEO Benefit Guide 19-20_FINAL

Vision Benefits 15

Medical Eye Services (MES) Vision Plan
When you enroll in an SBCEO medical plan, you are automatically enrolled in the MES Voluntary Vision plan. MES allows you
to receive vision care services from any provider you wish. When you access vision care from MES network providers, most
eligible services are covered at 100%. Vision care accessed from out-of-network providers is reimbursed to the patient up to
the maximums noted below.
MES Vision Plan #10148 –001

In-Network Non-Network
Vision Benefits
Copay
− Exam $5 copay $5 copay
Examination (Every Calendar Year) No charge Up to $40
Lenses (Every Other Calendar Year))
− Single Vision No charge Up to $30
− Bifocal No charge Up to $50
− Trifocal No charge Up to $65
− Progressive Up to $89.50 Up to $65
Frames (Every Other Calendar Year) Up to $150 Up to $40

Contact Lenses (Every Other Calendar Year) In Lieu of Frames and Lenses
− Cosmetic / Elective Up to $150 Up to $100
− Medically Necessary No charge Up to $250

Contact Information

Call 800-877-6372 or visit mesvision.com.