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 |