Vision benefits are separate from and in addition to the Medical Benefits of this Plan.
Vision Covered Expenses
Subject to the limits in the Summary of Benefits, the Plan pays the Maximum Allowable Charge for vision care services, as follows:
Subject to the limits in the Summary of Benefits. The Plan pays 80% of Usual and Customary charges for one examination per Covered Person in any Calendar Year (January 1 through December 31).
Frames, Lenses, and Contact Lenses
Subject to the limits in the Summary of Benefits. The Plan pays for frames, lenses, and contact lenses, including safety goggles and sunglasses to a Calendar Year (January 1 through December 31) maximum per Covered Person of $125.00.
Vision Exclusions and Limitations
The following Exclusions and limitations are in addition to those set forth in the sections entitled “General Limitations and Exclusions,” and “Summary of Benefits”:
Enrolled in a Training Program
Services performed by a Physician or other Provider enrolled in an education or training program when such services are related to the education or training program, except as specifically provided herein.
Eye refractions, eyeglasses, contact lenses, or the vision examination for prescribing or fitting eyeglasses or contact lenses (except for aphakic patients, and soft lenses or sclera shells intended for use in the treatment of Disease or Injury).
Treatment of glaucoma, cataract surgery and one set of lenses (contacts or frame-type).
Any charges that are covered under a medical or health plan that reimburses a greater
amount than this Plan.
Non Prescription Lenses
Charges for lenses ordered without a prescription or lenses that do not require a prescription.
Charges for orthoptics (eye muscle exercises).
Radial keratotomy or other plastic surgeries on the cornea in lieu of eyeglasses.
Charges for vision training or subnormal vision aids.