Insight Preferred Vision

Individual and Family 

VISION CARE SERVICES	In-Network Member Cost	Out-of-Network Allowance
Benefit Frequency Contact Lenses or Lens	Once every calendar year
Exam
Frame
Exam Exam	$50	Up to $35
Dilation	$0	N/A
Eye Exam Refraction	$0	N/A
Frames	80% of balance over $130	Up to $65
Lens Single Bi-focal Tri-focal	$10 copay (standard plastic) $10 copay (standard plastic) $10 copay (standard plastic)	Up to $25 Up to $40 Up to $55
Standard Progressive Lens	$75 copay	Up to $40