Eye Care Benefits

Services Offered - All services are offered once in a 12 month period. The contact Lenses Benefit and the Frame benefit cannot be used in the same 12 month period.
Lifetime Deductible—There is a lifetime-per-person deductible of $65.00 on Frames and Contact Lenses ONLY!
Service	Maximum Covered Expense
Examination - Includes case history; external examination of the eye and adnexa; ophthalmoscopic examination; determination of refracture status; binocular balance; tonometry text for glaucoma; gross visual field when indicated; summary finding; prescribing of lenses	$45.00
Frames	$65.00
Lenses (Per pair of lens-Patient pays the remainder)
Single	$40.00
Bifocal	$60.00
Trifocal	$75.00
No line bifocal or progressive power OR Lenticular	$80.00
Contact Lenses	$110.00

*Eligible applicants must be a member in good standing of CARE. The above monthly premium includes $1 monthly membership fee for CARE.

*Please refer to your certificate of insurance for complete details on all benefits, frequencies and plan limitations or view the limitations enclosed

Limitations and Exclusions on Vision coverage underwritten byAmeritas Group Dental and EyeCare:

Covered Expenses will not include and no benefits will be payable for expenses incurred for:

vision examinations more than once in any 12 month period
prescribed lenses more than once in any 12 month period
frames more than once in any 12 month period
contact lenses more than once in any 12 month period. When chosen, contact lenses shall be in lieu of any other lenses benefit during the 12 month period and in lieu of any other frame benefit during the 12 month period. When lenses are chosen, expenses for contact lenses are not Covered Expenses during the 12 month period
examinations performed or frames or lenses ordered before the Insured was covered under this section
subject to Extension of Benefits, any examination performed or frame or lens ordered after the Insured’s coverage under this section ceases
sub-normal vision aids
orthoptic or vision training or any associated testing
non-prescription lenses; replacement or repair of lost or broken lenses or frames except at normal intervals
any eye examination or corrective eye-wear required by an employer as a condition of employment
medical or surgical treatment of the eyes; any service or supply not shown on the Schedule of Eye Care Services
coated lenses; oversize lenses (exceeding 71 mm)
photo-gray lenses; polished edges
UV-400 coating and facets, and tints other than solid
lenses and frames during the first 12 months that a person is insured under this section, when the person is a Late Entrant, as defined.

Monthly Premium
Member Only	$7.48
Member + 1 (child or spouse)	$13.08
Member + 2 or more	$18.60

*Please refer to your certificate of insurance for complete details on all benefits, frequencies and plan limitations or view the limitations below.