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B. Lenses (spectacle--clear glass or plastic) <br />1. Single Vision Full Coverage <br />2. Standard Bifocals Full Coverage <br />3. Standard Trifocals Full Coverage <br />4. Special Lenses Full Coverage <br />(Aphakic & Lenticular) <br />C. Frames - Up to $50.00 Full Coverage <br />D. Contact Lens (in lieu of eyeglasses): <br />1. Cosmetic Contacts - up to $60.00 Full Coverage <br />2. Therapeutic Contacts - medically <br />necessary as stated in III, D.2. <br />up to $160.00 Full Coverage <br />V. PLAN DISCOUNTS AND POPULAR OPTION SCHEDULE <br />A. MATERIALS/SERVICE FEE/DISCOUNT <br />Frames 45% off retail <br />Lenses <br />Polycarbonate (Polylite) Lenses <br />Single Vision $28.00 <br />Multi focal $43.00 <br />Photo chromic (glass) <br />Single Vision $15.00 <br />Bifocal $30.00 <br />Lenses styles or types not covered 450 off retail <br />B. Miscellaneous <br />Contact Lenses 200 off retail <br />Non-prescription Sunglasses 250 off retail <br />Accessories and Contact Solutions 250 off retail <br />VI. PROGRAM EXCLUSIONS <br />A. Lenses not requiring prescription <br />B. Charges for lenses of a type or style not listed in <br />Sections III, B. l, 2, 3 and four <br />C. Anti-reflection or specialty coated lenses <br />D. Medical surgical treatment of eyes <br />E. Drugs or medication administered for the purpose of a <br />vision testing examination <br />3 <br />Rev. 11/13/02