For frames purchased in-network or out-of-network, your frame allowance may be applied toward non-prescription sunglasses.

• This benefit will be considered both a lens and a frame benefit for determining service intervals.
• Lab-fabricated Plano lenses are not covered.

• KidsCare Benefit applies only to covered children under age 18
• Once per Calendar Year Service Intervals:
  • Exam
  • Frames
  • Lenses/Contacts
• Out-of-network: Same as primary plan benefits up to the out-of-network exam and materials allowances stated above
• Covered children receive:
  • One additional comprehensive eye exam covered less any applicable copayment;
  • One additional pair of lenses or necessary contact lenses, or elective contact lenses less any applicable copayment, if:
    • the new prescription differs from the original by at least a .50 diopter sphere or cylinder, or
    • there is a change in the axis of 15 degrees or more, or
    • there is a .5 prism diopter change in at least one eye

• Additional coverage for members who have been diagnosed with type 1 or type 2 diabetes, glaucoma and age related macular degeneration (AMD)
• Preventive retinal screenings for members who have diabetes but don’t show signs of diabetic eye disease
• Exam: covered in full after $20 copay
• Special Ophthalmological Services covered in full

• Additional benefits for members who are not legally blind but whose eyesight cannot be corrected to 20/70 with the use of optical lenses; not available at retail chains including Costco, Walmart and Sam’s Club
• Supplemental testing: Maximum of two (2) tests covered in full within a two (2) year period up to the benefit maximum
• Supplemental aids: 75% of the allowable amount up to the benefit maximum every two (2) years
• Benefit maximum: $1,000 every two (2) years
• Requires pre-authorization