Schedule of Benefits 2026
(Benefit Coverage Plans A and B)
Download a PDF Copy| Benefit | Benefit Coverage Plan A In-network Plan | Benefit Coverage Plan B Out-of-network Plan |
|
|---|---|---|---|
| Vision Care | Routine eye exam every two years (every year for children up to age 18) | $10 copayment per visit | Paid at up to $75 for exam and glasses or contact lenses (every two years) |
| Eyeglasses or contact lenses every 2 years (through Davis Vision) | $30 copay for lenses and/or frames within the Davis Frame Collection, or $150 credit toward non-plan frames, or $25 copay for disposable/planned replacement lenses |
