Vision Benefits

Overview
To help you manage the cost of vision expenses, the Plan provides
vision care benefits for you and your family through National Vision Administrators (NVA). You can visit any vision care provider; however, benefits are greater if you use NVA providers.

Benefits of using NVA providers include:

NVA Schedule For Lens Options Not Covered Under The Basic Program The following is a schedule of amounts to be charged by a vision care provider for lens options not covered by the basic program.
National Vision Administrators Pricing Schedule For Lens Options
Lens Options	Pricing
Anti-Reflective Coating	$40.00
Blended Bifocal	$30.00
Edge Coat	$16.00
Faceted	$50.00
High Index (Single Vision)	$30.00
High Index (Single Vision) Spectralite	$40.00
High Index (Single Vision) 1.66	$54.00
High Index (Multifocal)	$50.00
High Index (Multifocal) Spectralilte	$60.00
High Index (Multifocal)	$69.00
Oversize (eye size over 55)	$10.00
Photochromatic (Single Vision)	$20.00
Photochromatic (Multifocal)	$30.00
Polycarbonate (Single Vision)	$25.00
Polycarbonate (Multifocal)	$30.00
Progressive (Basic)	$50.00
W / AR Coating	$90.00
W / Solid Coating	$60.00
Roll & Polish	$13.00
Scratch Resistant Coating	$10.00
Fashion Gradient Tints	$12.00
Transitions (Single Vision)	$65.00
Transition (Multifocal)	$70.00
Polarized	$75.00
If you select options listed in the schedule and you receive treatment through an NVA network provider, the provider cannot charge you more than the amount shown above for any listed option. If you select an option not included in the schedule, the provider should not charge you more than the lessor of the provider’s normal charge or the wholesale cost plus 25%.