BayCare Health System
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Plan
Frequencies
Exam every 12 months
Lenses every 12 months
Frames every 24 months

Copayment for each member at the time of service

Exam: $10
Lenses and/or frames: $15

Maximum Allowances Network Doctor
Non-network (After copayments/Up to plan limits)
Non-network
(copayments apply)
Eye Exam Paid in full $35
Lenses (per pair)    
Single Paid in full $20
Bifocal Paid in full $40
Trifocal Paid in full $60
Lenticular Paid in full $100
     
Contact Lenses    
Elective (exam & lenses) $150** + Exam $150** + Exam
Medically necessary* Paid in full $210
Frame $45 wholesale $45 retail
Lasik*** Members will receive a discount if Services are rendered by a TLC Network provider and they will pay no more than $1800/eye. No benefit