Vision Plan Benefits
| Benefit Frequency | Standard Plan | Enhanced Plan | ||
|---|---|---|---|---|
| Participating Provider | Non-Participating Provider | Participating Provider | Non-Participating Provider | |
| Examination: Once Every 12 months | Covered 100% | Reimbursement Amt: Up to $40 | Covered 100% After $10 copay | Reimbursement Amt: Up to $40 |
| Lenses: Once every 12 months | Standard Glass or Plastic | Standard Glass or Plastic | ||
| Single Vision | Covered 100% | Up to $30 | Covered 100% | Up to $30 |
| Bifocal | Up to $40 | Up to $40 | ||
| Trifocal | Up to $75 | Up to $75 | ||
| Lenticular | Up to $75 | Up to $75 | ||
| Solid Tints | N/A | N/A | ||
| Fashion Gradient Tints | N/A | N/A | ||
| Blended Bifocal (Segment) | N/A | N/A | ||
| Polycarbonates | 100% up to age 19 $25-$30 (fixed price for age 19 and over) | N/A | N/A | |
| Standard Progressive Lenses1 | $50 (fixed price) | N/A | N/A | |
| Premium Progressive Lenses2 | $100 (fixed price) | N/A | $100 (fixed price) | N/A |
| Photochromatic | N/A $20-30 (fixed price) | N/A | Covered 100% | N/A |
| Photogrey | N/A | N/A | ||
| Standard Transitions | $65-70 (fixed price) | N/A | N/A | |
| Standard Scratch Coating | $10 (fixed price) | N/A | N/A | |
| Frame: Once Every 12 Months | Retail Allowance Up to $150 (20% discount off balance)3 | Up to $50 | Retail Allowance Up to $150 (20% discount off balance)3 | Up to $30 |
| Contact Lenses: Once Every 12 months | In Lieu of Glasses | In Lieu of Lenses | ||
| Elective Contact Lenses | Up to $150 Retail 15% (Conventional) or 10% (Disposable) off balance4 | Up to $130 | Up to $150 Retail 15% (Conventional) or 10% (Disposable) off balance4 | Up to $130 |
| Contact Lens Evaluation/Fitting5 | Covered 100% after $20 Daily Wear $30 Extended Wear $50 Specialty Wear copay | Daily Wear: up to $20 Extended Wear: up to $30 Specialty Wear: up to $50 | Covered 100% after $20 Daily Wear $30 Extended Wear $50 Specialty Wear copay | Daily Wear: up to $20 Extended Wear: up to $30 Specialty Wear: up to $50 |
| Medically Necessary6 | Covered 100% | Up to $260 | Covered 100% | Up to $260 |
| Low Vision Aids6: Once Every 2 Years | Up to $999 | N/A | Up to $999 | N/A |
1 Standard Progressive Lenses — Multifocal lenses with no lines. There is not a harsh jump in focus that bifocal and trifocal wearers experience because the change is gradual. See a complete list of Standard Progressive Lenses here.
2 Premium Progressive Lenses — Multifocal lenses with no lines, but made with state-of-the-art technology. Visit here for a complete list of Premium Progressive Lenses that are covered.
3 Discount does not apply at Walmart or Sam’s Club locations or certain proprietary brands or where prohibited by law. Discounts are not insured benefits.
4 Discount does not apply at Walmart or Sam’s Club locations or Contact Fill.
5 Fittings vary at Walmart/Sam’s Club locations and are only covered if you choose Contact Lenses.
6 Prior authorization required from NVA.
| Standard Plan | Enhanced Plan | ||
|---|---|---|---|
| $40 Standard Blue Light Blocker | $40 Standard Anti-Reflective Coating | $40 Standard Blue Light Blocker | $40 Standard Anti-Reflective |
| $60 Premium Blue Light Blocker | $75 Polarized | $60 Premium Blue Light Blocker | $12 Ultraviolet Coating |
| $150 Ultra Blue Light Blocker | $55 High Index | $150 Ultra Blue Light Blocker | $75 Polarized |
| $55 High Index | |||
Vision insurance coverage is provided by National Vision Administrators® (NVA). Since 1979, NVA has built a quality reputation for Vision Insurance featuring great customer support and a strong nationwide network of providers that give unparalleled service to its customers. 
