 |
||||
 |
||||
| Benefit | VIP Premier | M-Plus | Best Choice | Emerald |
|
||||
| Vision Benefits | ||||
|
||||
| Annual Deductible | $25 per person | None | None | $20 per person |
|
||||
| Eye Exam | Every 12 months 100% covered |
As often as you wish $36 co-pay |
As often as you wish $36 co-pay |
Every 12 months 100% covered |
|
||||
| Lenses | Every 12 months 100% covered |
As often as you wish |
As often as you wish with co-pay |
Every 12 months 100% covered |
|
||||
| Frames | Every 12 months 100% covered |
As often as you wish 25% discount |
As often as you wish 25% discount |
Every 12 months 100% covered |
|
||||
| Cosmetic Contact Lenses | Every 12 months in addition to the basic benefit or, if desired, in lieu of the basic benefit, $100 applies to the doctor's usual and customary package fee which includes eye examination, fitting and contact lenses. |
As often as you wish |
As often as you wish |
Every 12 months in addition to the basic benefit or, if desired, in lieu of the basic benefit, $100 applies to the doctor's usual and customary package fee which includes eye examination, fitting and contact lenses. |
|
||||
| Medically Necessary Contact Lenses | Every 12 months A $250 benefit after co-pay |
Available as custom contact lenses at 20% off. | Available as custom contact lenses at 20% off. | Every 12 months A $250 benefit after co-pay |
|
||||
| Dental Benefits | ||||
|
||||
| Office Visit | N/A | N/A | $5 co-pay | No Charge |
|
||||
| Dental Exam | N/A | N/A | No Charge | No Charge |
|
||||
| X-rays | N/A | N/A | No Charge | No Charge |
|
||||
| Cleaning | N/A | N/A | No Charge | No Charge |
|
||||
| Floride Treatment | N/A | N/A | No Charge - to age 14 | No Charge - to age 14 |
|
||||
| Amalgam Filling | N/A | N/A | 1 Surface: $10 co-pay |
1 Surface: $2 co-pay 2 Surfaces: $3 co-pay |
|
||||
| Bi Rooted Canal | N/A | N/A | $150 without restoration | $45 without restoration |
|
||||
| Orthodontia | N/A | N/A | Covered | Covered |
|
||||
| View Details | View Details | View Details | View Details | |
| Dental Co-Payments | Dental Co-Payments | |||
| Signup Now | Signup Now | Signup Now | Signup Now | |
|
||||