Vision Benefits

Name: Coastal Carriers
Address: United States

Benefits	In-Network	Out-of-Network
Routine Eye Exam	$10 Copay	Up to $40
Lenses Single Bifocal (Lined) Trifocal (Lined) Lenticular (Lined)	$25 Copay $25 Copay $25 Copay $25 Copay	Up to $20 Up to $40 Up to $60 Up to $110
Frames	$0 Copay 20% off balance over $130 Allowance	Up to $52
Contact (Disposable)	$25 Copay plus balance over $130 Allowance	Up to $78
Frequency
Exam	Once every 12 months	Once every 12 months
Frames	Once every 24 months	Once every 24 months
Contacts	Once every 12 months	Once every 12 months
Plan allows member to receive either frame and lens services, or frame and contacts in the same year