 Vista Health Plan - Summary of Vision Benefits |
| EYE EXAMINATION |
$19.00 |
| EYEGLASSES |
|
| Select Plan Frame |
No
Charge |
|
|
| Single Vision Lens |
$20.00 |
| Bifocal Lenses |
$25.00 |
| Trifocal Lenses |
$30.00 |
|
|
| Prescription Tint - Solid Brown C, Solid Gray C or
Solid Green C |
No
Charge |
|
|
| Other upgrades are available at discounted pricing. |
|
|
|
| CONTACT LENSES |
|
| Medically Necessary Contact Lenses -
Evaluation / Fitting |
Covered
in full |
|
|
Non-Medically Necessary Contact Lenses -
Evaluation / Fitting |
Not covered,however,
Primary Plus Participating
Providers will charge a maximum of $45.00 to Vista-SFL
members |
|
|
Hardware / Lenses |
|
| Daily Wear Lenses: |
|
| Bausch & Lomb, Biomedics |
$10.00 |
| Extended Wear Lenses: |
|
| Bausch & Lomb, Biomedics |
$15.00 |
| Disposable Lenses (2 boxes) |
|
| All clear, spherical disposable lenses |
$48.00 |
|
|
|
All other disposables (colored lenses, bifocal lenses,
etc.) are available at a 20% discount from provider's
usual and customary charge. |
|
All eyewear outside Select Plan, daily
wear and extended wear contact lenses are available
at a 25% discount from the provider's usual and customary
charge.
|
|
|
|
 |
More Options :
Please click on the link above to read more about the Dental Benefits of the Vista Health Plan.
