

| Exam Copay | $10 |
| Materials Copay | $25 |
| Frame Allowance | $130 |
| Frame Allowance @ Walmart @ Sam's Club @ Costco | $70 |
| Elective contact lens allowance | $130 |
| Necessary contact lenses | 100% after copay |
| Contact lens fit/eval copay | $60 |
| Frames + contacts in same year | No; contacts in lieu of frames |
| Exam Copay | $10 |
| Materials Copay | $10 |
| Frame Allowance | $150 |
| Frame Allowance @ Walmart @ Sam's Club @ Costco | $80 |
| Elective contact lens allowance | $150 |
| Necessary contact lenses | 100% after copay |
| Contact lens fit/eval copay | $60 |
| Frames + contacts in same year | No; contacts in lieu of frames |
| Exam Copay | $0 |
| Materials Copay | $0 |
| Frame Allowance | $175 |
| Frame Allowance @ Walmart @ Sam's Club @ Costco | $95 |
| Elective contact lens allowance | $175 |
| Necessary contact lenses | 100% after copay |
| Contact lens fit/eval copay | $60 |
| Frames + contacts in same year | No; contacts in lieu of frames |
| Exam Copay | $0 |
| Materials Copay | $0 |
| Frame Allowance | $200 |
| Frame Allowance @ Walmart @ Sam's Club @ Costco | $110 |
| Elective contact lens allowance | $200 |
| Necessary contact lenses | 100% after copay |
| Contact lens fit/eval copay | $60 |
| Frames + contacts in same year |