Vision Benefits

Name: Visiting Nurses Association
Address: United States

	In-Network	Out-of-Network
Eye Exam w/Dilation	$10 Copay	Up to $35
Imaging	Up to $39	N/A
Frames	$120 Allowance	Up to $60
Standard Lenses Single Vision Bifocal Trifocal	$25 Copay $25 Copay $25 Copay	Up to $25 Up to $40 Up to $65
Contact Lenses Fit and Follow Up Lenses Medically Necessary	Up to $40 $135 Allowance Paid in Full	N/A Up to $108 Up to $200
Frequency Exam Lenses or Contact Lenses Frames	Once Every 12 Month Once Every 12 Months Once Every 24 Months	Once Every 12 Months Once Every 12 Months Once Every 24 Months

Full-Time & Part-Time Per Pay Period Rate
Employee	$2.99
Employee + Spouse	$5.69
Employee + Child(ren)	$5.98
Family	$8.80

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