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DENTAL –
BC/BS
Vision – BC/BS
In-Network
Out-of-Network
Routine Eye
Exam
$20 Copayment
Benefits Not Available
Lenses and
Frames
Covered up to $80, then 90%
The plan will pay for either one pair of prescription eyeglasses,
one pair of hard or soft contact lenses, or a one-year supply of
disposable contact lenses per year. Any services in excess of this
benefit period maximum are not covered services.
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