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SPECTERA VISION PLAN

SPECTERA VISION PLAN. In Network Out of Network CoPay Exam $10 N/A CoPay Materials $20 N/A Eye Exam 100% after CoPay Up to $40 Spectacle Lenses Single Vision 100% after CoPay Up to $40 Bifocal (lined) 100% after CoPay Up to $60 Trifocal (lined) 100% after CoPay Up to $80

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SPECTERA VISION PLAN

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  1. SPECTERA VISION PLAN In NetworkOut of Network CoPay Exam $10 N/A CoPay Materials $20 N/A Eye Exam 100% after CoPay Up to $40 Spectacle Lenses Single Vision 100% after CoPay Up to $40 Bifocal (lined) 100% after CoPay Up to $60 Trifocal (lined) 100% after CoPay Up to $80 Frame Allowance 100% up to $50 Up to $45 wholesale. Amounts retail above pay difference

  2. SPECTERA VISION PLAN In-Network Out of Network Contact Lenses (elective- fitting, f/u & lenses) Covered in full 100% Up to $125 All over elective Up to $125 Up to $125 Contact Lenses 100% after CoPay Up to $210 (Medically Necessary) LASIK A preferred rate N/A $1500 per eye for PRK $1800 for LASIK

  3. SPECTERA VISION PLAN Service Frequency Exam- 12 months Lenses- 12 months Frames- 24 months Rate Employee $7.06 Employee+ Child $14.24 Employee + Spouse $13.58 Family $21.62 Network includes WalMart optical, Pearle Vision, and other providers @ https://www.spectera.com/vision Click future member

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