

Home | Live In WV | Work at WVUH-East | Benefits | Contact
| Benefit Provision | In-Network | Out-of-Network |
|---|---|---|
| Eye Exam | $10 copay per 12-month period | Up to $35 per 12-month period |
| Single Vision | $25 copay per 12-month period | Up to $25 per 12-month period |
| Bifocal | $25 copay per 12-month period | Up to $40 per 12-month period |
| Trifocal | $25 copay per 12-month period | Up to $55 per 12-month period |
| Frames | Covered up to $120 after a $25 copay per 24-month period | Up to $45 per 24-month period |
| Contact Lenses | Covered up to $105 per 12-month period | Up to $105 per 12-month period |