In-Network Out-of-Network $10 copayment Comprehensive Vision Exam Up to $39 copay for retinal Up to $45 screening 2023 Frames $130 allowance; 20% off Up to $70 amount over $130 VISION PLAN Single Vision Lenses $25 copayment Up to $30 Bifocal Lenses $25 copayment Up to $50 Trifocal Lenses $25 copayment Up to $65 Contact Lens Fit Up to $60 copay; 15% $0 discount off provider fees Contact Lenses $130 allowance Up to $105 (in lieu of glasses) Frequency of Services Examination Once every 12 months Lenses or Contacts Once every 12 months Frames Once every 24 months [ 15 ]