Blue Cross Blue Shield FEP Vision
Section 4 Your Cost for Covered Services

If you are enrolled in Standard Option, you must stay in-network for covered services. If you receive care from a non-participating provider, we will not pay for any services unless you reside in a limited access area.

If you are enrolled in High Option, you’ll get more out of your coverage and pay lower out-of-pocket costs when you see a BCBS FEP Vision network doctor. Plus, there are no claim forms to submit when you see an in-network doctor. When you visit an out-of-network provider, you will be reimbursed according to the schedule shown in the chart below. You will be responsible for charges billed over the amounts shown.

Services/Material: Vision Care Exam
We Pay: Up to $30
Services/Material: Single Vision Lenses
We Pay: Up to $25
Services/Material: Bifocal Lenses
We Pay: Up to $35
Services/Material: Trifocal Lenses
We Pay: Up to $45
Services/Material: Lenticular Lenses
We Pay: Up to $45
Services/Material: Elective Contact Lenses
We Pay: Up to $75
Services/Material: Medically Necessary Contact Lenses
We Pay: Up to $225
Services/Material: Frames
We Pay: Up to $30

Please see Section 3, How You Obtain Care, for more information.