"OPTICAL" PLANS
PROVIDED BY MEDIAL EYE SERVICES

Eye Care & Eyewear Plan

The Plan provides Full coverage for covered services and/or materials when provided by a participating provider of the Eye Care Network. Directories of participating providers are available on request.

Coverage: $10 Deductible

• One Comprehensive examination in any 24 consecutive months, with a follow-up examination at a 12-month interval.

• One pair of standard lenses in any 24 consecutive months, or at a 12 month interval is the prescription change so indicates. (Standard lenses fit any frame with an eye size less then 56mm.)

• One standard frame in any 24 consecutive months (A standard frame is any frame that has a maximum retail cost of $60 or less).

• One pair of contact lenses in any 24 consecutive months, or at a 12 month interval if the prescription change so indicates. (This benefit is in lieu of lenses and frames).

• If contact lenses are for cosmetic or convenience purposes, the plan will pay $100 toward their cost. Any balance is the patients responsibility.

• If contact lenses are medically necessary, they are a fully covered benefit: Following cataract surgery; or when visual acuity cannot be corrected to 20/70 in the better eye except through the use of contacts; or when necessitated by anisometropia or keraroconus. A report from the Eye Care Specialist is required

Benefits Provide by Non-Participating Providers:

Benefit frequencies are the same as listed under the participating providers section.

Eye Wear Only Plan:

The Plan Provides Same Level of Benefits for Frames and Lenses. No Benefits for Examinations. (Health Net and Kaiser HMO's Provide Full Exam Benefit). There is no Deductible for Eyewear.