Plan Details
Plan Name	Premier Plan
Effective Dates	Jan 01, 2024 to Jan 01, 2025
Benefits	In-Network	Out-of-Network
Exam Copay	$20	$45 up to
Materials Copay	$20	Based on fee schedule
Exam Frequency	12 months	12 months
Lenses Frequency	12 months	12 months
Frames Frequency	24 months	24 months
Contacts Frequency	12 months	12 months
Single Vision Lens	$20	$30 up to
Medically Necessary Contacts	N/A	N/A
Elective Contacts	$200 allowance	$105 up to
Frames	$200 allowance; $250 Featured Frame Brands allowance $250 Visionworks frame allowance on any frame $200 frame allowance 20% savings on the amount over your allowance $110 Walmart/Sam's Club/Costco frame allowance	$70 up to
Corrective Vision Services (e.g. Laser Surgery)	Discount available	Not covered
Second Pair of Glasses	Discount available	Not covered