CHOICES HEALTH CARE PLAN BENEFITS - MyAlcoaBenefits

Vision Coverage
Your Vision Plan
In-Network*
Out-of-Network
Annual Deductible None None
Routine Vision Exam
(once per calendar year)
100% Up to $35
Standard Lenses**
(per set; once per calendar year)
Single Vision 100% Up to $35
Bifocal 100% Up to $51
Trifocal 100% Up to $68
Lenticular (Biconvex) 100% Up to $80
Frames
(once every two calendar years)
Contact Lens Fitting
(once per calendar year)
Contact Lenses
(instead of standard lenses;
once per calendar year)
100% up to $100 retail Up to $30
100% Up to $35
100% up to $105 retail Up to $68
* In-network providers aren’t obligated to accept these benefit amounts in special retail sales or packages; you may be required
to pay the sale/package price and be reimbursed by the claims administrator at the out-of-network rate.
** Amounts shown are for standard lenses only. Lens options such as coatings, tints, and progressive bifocals aren’t covered.
If you choose non-standard lens features, you pay the difference. In-network providers offer a discount on these lens features.
CHOICES HEALTH CARE PLAN BENEFITS 9