Discount on Lasik services Sample Clauses

Discount on Lasik services. The Plan must provide a discount for Lasik services. Plan Design Calendar Year Deductible $0 Calendar Year Maximum Benefit Unlimited Frequency Network Out-of-Network Exam 12 months 12 months Lenses 12 months1 12 months Frames 24 months 24 months Benefits Eye Exam (with dilation as necessary) 100% after $10 copay $40 allowance Frames $75 wholesale allowance $60 retail allowance Lenses - Standard Plastic2 Single 100% after $10 copay $40 allowance Bifocal 100% after $10 copay $60 allowance Trifocal 100% after $10 copay $80 allowance Contact Lenses3 Medically Necessary 100% $100 allowance Elective $150 allowance1 $75 allowance Miscellaneous Benefits Scratch Resistant Lenses5 $25 allowance Not Covered Anti-Reflective Lenses6 $50 allowance Not Covered Lasik Discount Available4 Not Covered 1 Coverage applies to either glasses or contact lenses in a Plan Year.

Discount on Lasik services. The Plan Design must provide a discount for Lasik services. See table below for further detail on coverage benefits. Plan Design Calendar Year Deductible $0 Calendar Year Maximum Benefit Unlimited Frequency Network Out-of-Network Exam 12 months 12 months Lenses 12 months1 12 months Frames 24 months 24 months Benefits Eye Exam (with dilation as necessary) 100% after $10 copay $40 allowance Frames $125 wholesale allowance $100 retail allowance Lenses - Standard Plastic2 Single 100% after $10 copay $40 allowance Bifocal 100% after $10 copay $60 allowance Trifocal 100% after $10 copay $80 allowance Contact Lenses3 Medically Necessary 100% $100 allowance Elective $150 allowance1 $75 allowance Miscellaneous Benefits Scratch Resistant Lenses $40 allowance Not Covered Anti-Reflective Lenses $70 allowance Not Covered Lasik Discount Available4. Not Covered 1 Coverage applies to either glasses or contact lenses in a Plan Year. 2 The Plan Design will cover only the basic cost of lenses. The insured is responsible for lens options selected, unless otherwise specified in the Plan Design or deemed Medically Necessary. These options may include, but are not limited to: blended lenses; progressive multifocal lenses; photocromatic lenses, tinted lenses, sunglasses, prescription and plano; etc. After copay, standard polycarbonate lenses are available at no charge for Participants less than nineteen (19) years old.