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Adult Routine Vision Services (for Members age 19 and older)

Comprehensive Vision Exam

(Limited to 1 each calendar year)Routine Retinal Screening Prescription Glasses
Limited to 1 pair of frames every calendar year (up to a $150 allowance)

Limited to 1 pair every calendar year
Glass or plastic single vision, lined bifocal, lined trifocal or lenticular lenses
Prescription Contact Lenses
In lieu of prescription glasses, materials and services are limited to 1 pair of contact lenses up to $150 every calendar year.
Medically necessary contact lenses for specified medical conditions require Prior Authorization.
Vision benefits included for children through age 18, and available for adults who purchase plans with adult vision benefits. click here to find a list of eye doctors or call Vision Service Plan (VSP) at (844) 292-4903

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