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$55 for high index lenses.

$15 for single vision super shield (scratch protection) coating.

$25 for multifocal vision super shield (scratch protection) coating.

$70 for single vision transition (sun sensitive plastic) lenses or for multifocal vision transition (sun sensitive plastic) lenses.

$25 for each pair of standard or soft daily wear (non-disposable) contact lenses.

$55 for an initial supply of disposable or planned replacement contact lenses.

The member will pay no more than 2 inpatient copayments for any covered admission during each calendar year.

The member will pay no more than 2 inpatient copayments for any covered admission during each calendar year.

The member will pay no more than 2 inpatient copayments for any covered admission during each calendar year.

The member will pay no more than 2 inpatient copayments for any covered admission during each calendar year.