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Vision

National Vision Administrators

Coverage period: January 1, 2025 – December 31, 2025

 Services In-Network Out-of-Network
Examination
Once Every Plan Year
Covered 100% (Reimbursement Amounts) Up to $35
Lenses
Once Every Plan Year
Standard Glass or Plastic Covered 100% Single Vision Up to $25
Bi-focal Up to $45
Tri-focal Up to $75
Lenticular Up to $75
Frame
Once Every Plan Year
Covered up to $85
Retail Allowance 3
(20% discount off remaining balance over $85 allowance) 4
Up to $45
Contact Lenses
Once Every Plan Year
(In lieu of Lenses/Frames) (In lieu of Lenses/Frames)
Elective Covered up to $60 Retail Allowance 5 (15% discount (Conventional) or 10% discount (Disposable) off remaining balance over $60) 6 Up to $45
Fit & Follow-Up 1    
Standard Daily Wear Covered 100% Daily Wear: $20
Standard Extended Wear Covered 100% Extended Wear: $30
Specialty Wear Covered 100% after $10 Copay Specialty: $50
Medically Necessary 2 Covered 100% $120
  1. Covered only if member chooses Contact Lenses.
  2. Prior Authorization required from NVA. Includes fitting & follow-up.
  3. Includes frames up to $32 Every Day Low Price-price point at Walmart/Sam’s Club locations (if included in network).
  4. Discount does not apply at Walmart/Sam’s Club locations or for certain proprietary frame brands or where prohibited by law.
  5. $42 Every Day Low Price-price point for contact lenses at Walmart/Sam’s Club locations (if included in the network).
  6. Discount does not apply at Walmart/Sam’s Club locations, Cole corporate locations (if applicable) or Contact Fill. Prohibited by some manufacturers or where prohibited by law.

NOTE: If covered participants choose extra options, they are responsible for the additional cost of the options paid directly to the ECP

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