WVUH-East - Benefits - Vision Plan

Employment

Benefit Provision	In-Network	Out-of-Network
Eye Exam	$10 copay per 12-month period	Up to $35 per 12-month period
Single Vision	$25 copay per 12-month period	Up to $25 per 12-month period
Bifocal	$25 copay per 12-month period	Up to $40 per 12-month period
Trifocal	$25 copay per 12-month period	Up to $55 per 12-month period
Frames	Covered up to $120 after a $25 copay per 24-month period	Up to $45 per 24-month period
Contact Lenses	Covered up to $105 per 12-month period	Up to $105 per 12-month period