In-Network: 
VIS178 
•$0 copayment for routine exam up to 1per year. 
•$115 maximum benefit coverage amount per year for contact  
lenses, eyeglasses-lenses and frames, fitting for eyeglasses-lenses  
and frames or 1pair of select eyeglasses at no cost. 
•Eyeglasses include ultraviolet protection and scratch resistant  
coating. 
Refraction is only covered when billed as part of the routine vision  
exam. 
Search for Vision providers in the Medical network of this Medicare  
Advantage plan.