Vision
Vision Insurance
Group Name: Cuesta College
Group #: 30071230
General Plan Information | In - Network | Out-of-Network |
---|---|---|
Copay | ||
Examination | 100% | up to $50/optometric; up to $60/ophthalmologic |
Benefit Frequency | ||
Examination | 12 months | 12 months |
Lenses | 12 months | 12 months |
Frames | 12 months | 12 months |
Contacts | 12 months | 12 months |
Covered Services | ||
Lenses | ||
Single Vision Lens | 100% | up to $43 |
Bifocal Lens | 100% | up to $60 |
Trifocal Lens | 100% | up to $75 |
Lenticular | 100% | up to $120 for Monofocal; up to $200 for Multifocal |
Contact Lenses | ||
Medically Necessary | 100% prior authorization is required | up to $200/hard; up to $250/soft; prior authorization is required |
Elective | up to $150 | up to $120 |
Frames | up to $200 | up to $40 |