GOLD 125

In Network: Out of Network:

Vision exam: Paid in full after co-pay Up to $35.00

Frame: Up to $125.00 after co-pay Up to $55.00

Lenses:

Single Vision (pr) Paid in full Up to $25.00

Bifocal (pr) Paid in full Up to $40.00

Trifocal (pr) Paid in full Up to $45.00

Lenticular Paid if full Up to $80.00

Contact Lenses:

Elective Up to $125.00 Up to $65.00

Medically required Paid in full Up to $150.00

Laser Vision Correction $250 in or out of network

MONTHLY RATES

EE $6.36

EE+1 $10.85

EE/F $15.95