| Services/Materials | You will be reimbursed up to: |
| Eye examination | $30.00 |
| One frame | $25.00 |
| One pair lenses (single vision) | $23.25 |
| One pair lenses (bifocal) | $37.50 |
| One pair lenses (trifocal) | $50.50 |
| One pair contact lenses (materials and fitting) | $82.00 |
| Services/Materials | You will be reimbursed up to: |
| Eye examination | $30.00 |
| One frame | $25.00 |
| One pair lenses (single vision) | $23.25 |
| One pair lenses (bifocal) | $37.50 |
| One pair lenses (trifocal) | $50.50 |
| One pair contact lenses (materials and fitting) | $82.00 |