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If you use non-participating providers
When you receive eye care services or materials from a non-participating provider, you pay the cost and then submit a claim for reimbursement. Your reimbursement is based on the type of service up to the following maximums:
Service/Material
Benefit amount
Exam
  • $35
Lenses
 
  • Single vision
  • $40
  • Bifocal
  • $60
  • Trifocal or lenticular
  • $80
Frames
  • $45
Contact Lenses
 
  • Conventional
  • $105
  • Disposable
  • $105