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~' <br />III. COVERED VISION SERVICES - DEFINITIONS <br />B. Frames <br />1. Standard first quality eyeglass frames, adequate <br />to hold two lenses <br />C. Lenses - Definition <br />1. Covered spectacle lenses equal to first quality <br />lenses, which meet 280.1 or 280.2 standards of the <br />American National Standards Institute. <br />D. Contact lenses <br />1. Cosmetic prescription contact lenses are lenses <br />designed to fit over the cornea for the purpose or <br />correcting vision. <br />2. Therapeutic (medically necessary) contact lenses <br />are lenses designed to fit over the cornea. They are <br />for the purpose of achieving 20/70 in the better eye <br />when that acuity is not attainable through prescription <br />eyeglasses, or for keratoconus, irregular astigmatism <br />or irregular corneal curvature. If the actual charge <br />exceeds the maximum plan benefit, the patient will be <br />charged for the amount in excess of the plan benefit. <br />E. Network Coverage <br />Services provided through any Union Eye Care Center <br />location. <br />F. Non-Network <br />Coverage provided through locations other than <br />Union Eye Care Center or network affiliate locations. <br />IV. NETWORK COVERAGE - Through Union Eye Care Center <br />A. Eye examination including Tonometry (Glaucoma Test) <br />1. Spectacle - Eyeglass Full Coverage <br />2. Contact Lens - Up to $35.00 full Coverage <br />2 <br />Rev. 07/17/09 <br />