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| Eye Exam |
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Routine Eyeglass exam |
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$10 co-pay |
| Routine Contact exam |
$10 co-pay |
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| Lenses |
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Plastic: Single Vision,bifocal,or trifocal |
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100% Covered |
| Progressive lenses (Standard plastic no-line **) |
$30 co-pay |
| Glass Lenses |
15% Discount |
| Polycarbonate |
$40 co-pay |
| High Index |
$80 co-pay |
| Lenticular |
100% Covered |
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** Co-pays for progressive lenses may vary with lens options and materials |
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| Coatings |
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Scratch resistant coating |
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100% Covered |
| Ultra Violet protection |
100% Covered |
| *Scratch and UV are not covered benefits outside of Utah. |
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| Other Options: A/R, edge polish, tints, mirrors, etc. |
25% Discount |
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| Frames |
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Allowance Based on Retail Pricing |
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$100 Allowance |
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| Additional Pairs |
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Additional pairs of glasses throughout the year |
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50% off Retail |
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| Contact Lenses |
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Contact benefit is in lieu of lens and frame benefit |
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$100 Allowance |
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| Additional Contact Purchases |
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Conventional |
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Up to 20% Discount |
| Disposables |
Up to 10% Discount |
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| Discounts |
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Any item listed as a discount in the benefit outline above is a merchandise discount only and not an insured benefit |
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| Refractive surgery (LASIK) |
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$100.00 off per eye |
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LASIK services are not an insured benefit - this is a discount only
Surgery through Physicians Laser Center of SLC, UT
All pre & post operative care provided by Standard Optical
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| Optical Options not listed above |
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Approved providers offer discounts on any items or upgrades not specifically listed on this benefit outline. In general this is done by subtracting the relative value of the above related benefit from the retail price of the desired optional item. Please call any of our approved providers for full details or prices. |
