Schedule of Vision Expense Benefits

SCHEDULE OF VISION EXPENSE BENEFITS

CITY OF LEWISVILLE

Plan Benefits Effective: October 1, 2007

VISION CARE BENEFITS
Type of Service	Benefits
Vision Exam	$50 per Exam
Conventional Lenses single vision bifocal vision trifocal vision lenticular vision	$35 per pair $50 per pair $60 per pair $100 per pair
Contact Lenses (In Lieu of Eyeglasses/Each calendar year)	$100 per Calendar Year
Frames (Each calendar year)	$75 per Calendar Year

Both Contact Lenses and Eyeglasses (Frames and Lenses) not allowed in same Calendar Year.