Your vision benefit is provided through Medical Eye Specialists.


Schedule of Benefits
Enrollment Form
Claim Form
Privacy Notice



Please refer to your Certificate of
Insurance for details on the process and administration of your coverage.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vision Benefits

The Policy provides full coverage for Covered Services, less a $10.00 copay for the examination and a $10.00 copay for the materials, when you go to a Participating Provider of The MESVision Network (MES). If Covered Services are provided by a Non-Participating Provider, charges will be paid, ,less a $10.00 copay for the examination and a $10.00 copay for the materials, but not to exceed the following Schedule of Allowances.

 

 

 

Plan Summary

	In-Network Coverage (Using a Network Provider)	Out-of-Network Coverage (Using a Non-Network Provider)
Examination	Your Co-payment: $10	Covered up to $40
Lenses	Your Co-payment: $10 The co-payment covers standard lenses at 100%: • Single Vision • Bifocal (FT-25, FT-28, Round) • Trifocal (7x25, 7x28) If you wish to purchase non-standard lenses (not covered at 100%), you will be responsible for the difference: • SV Polycarbonate Lenses for dependent children - covered up to $75 • Progressive  - cvered up to $89.50	Your Co-payment: $10 • Single Vision    Covered up to $40 • Bifocal    Covered up to $60 • Trifocal   Covered up to $80 • SV Polycarbonate upgrade for members under 18 years Covered up to $50 • Progressive    Covered up to $80
Frame	Allowance: $100	Covered up to $60
Cosmetic/Elective Contact Lenses	Allowance: $135 Available in lieu of all other eyewear equipment (not exam).	Covered up to $122
Medically Necessary ContactLenses	Paid-in-Full Prior authorization by MES is required.	Covered up to $210 Prior authorization by MES is required.