| Exams |
One every calendar year, two every calendar year up to age 18 |
Basic Plan - Network $10 copayment |
Premium Plan - Network $10 copayment |
Ultra Plan - Network $10 copayment |
Non-Network NVA pays up to $45 |
| Lenses |
Once every calendar year
Single-vision, bifocal, trifocal, lenticular |
Basic Plan - Network $25 copayment |
Premium Plan - Network $25 copayment |
Ultra Plan - Network $25 copayment Lens includes scratch coating, UV protection, Polycarbonate, tints, AR coating (tier 1) & Progressive Lenses Tiers 1 & 2 |
Non-Network Maximum amount NVA pays varies based on type of lenses |
| Frames |
Once every two calendar years, once every calendar year up to age 18 |
Basic Plan - Network Up to $125 retail allowance and 20% discount off remaining balance |
Premium Plan - Network Up to $175 retail allowance and 20% discount off remaining balance |
Ultra Plan - Network Up to $175 retail allowance and 20% discount off remaining balance |
Non-Network NVA pays up to $70 |
| Contact Lenses – Elective (You prefer contacts to glasses.) |
Once every calendar year in place of eyeglass lenses |
Basic Plan - Network Up to $125 retail allowance and 15% discount off conventional or 10% discount off disposable remaining balance |
Premium Plan - Network Up to $175 retail allowance and 15% discount off conventional or 10% discount off disposable remaining balance |
Ultra Plan - Network Up to $175 retail allowance and 15% discount off conventional or 10% discount off disposable remaining balance |
Non-Network NVA pays up to $105 |
| Contact Fitting and Evaluations |
For daily contact lenses, extended contact lenses and specialty contact lenses |
Basic Plan - Network $20 to $50 copayment depending on type of lenses |
Premium Plan - Network $20 to $50 copayment depending on type of lenses |
Ultra Plan - Network $0 Copayment |
Non-Network NVA pays up to $20 to $30 depending on type of lenses |