Vision Coverage
Vision Coverage
Aetna Vision PreferredSM is administered by EyeMed Vision Care and is automatically included with the Aetna Choice POS II Plan. Important note: Although your vision coverage is bundled with medical, your network of providers are different. You can locate a provider in the Aetna Vision Preferred Network at www.aetnavision.com.
SUMMARY OF PLAN AND COVERAGE
The following table shows the Aetna Choice POS II Plan details.
| Plan Features | In-Network Services | Out-of-Network Services |
| Exam with Dilation as Necessary (once every calendar year) | $25 copay | $50 |
| Exam Options – | ||
| Standard Contact Lens Fit and Follow-Up | Up to $55 | N/A |
| Premium Contact Lens Fit and Follow-Up |
10% off retail price | N/A |
| Frames: Any Available Frame at Provider Location (once every two calendar years) | $0 copay; $110 allowance; 20% off balance over $110 | $70 |
| Â Standard Plastic Lenses (once every two calendar years) | ||
|  – Single Vision | $25 copay | $50 |
|  – Bifocal | $25 copay | $75 |
|  – Trifocal | $25 copay | $100 |
|  – Lenticular | $25 copay | $100 |
| Â Contact Lenses (Contact lenses allowance includes materials only. Once every calendar year) | ||
|  – Conventional | $0 copay; $110 allowance, 15% off balance over $110 | $105 |
| – Disposable | $0 copay; $100 allowance, plus balance over $110 | $105 |
|  – Medically Necessary |  $0 copay; Paid-in-full |  $210 |
| Â Laser Vision Correction | Â 15% off retail price or 5% off promotional price | Â N/A |