Opticare Vision Services
All Insured/ Funded Plans
Reimbursement Schedule

Routine Exam (including dilation) Plan Pay is $45 (less patient copay)
Fitting/Eval Plan Pay is 80% of U&C – unless plan states patient responsibility
Frames (Based on specific Member’s allowance) Standard & Deluxe Plan Pay is 50% of frame retail price (less patient responsibility). Member pays the balance over their allowance
Lenses
V2100 Single vision lenses (Std plastic) Plan Pays $35
V2200 Bifocal lenses (std plastic) Plan Pays $50
V2300 Trifocal lenses (std plastic) Plan Pays $75
Progressive allowance (may vary by plan) Covered for Basic Progressive Only – see below for details
V2781 Standard Progressive Plan Pays $90 less applicable member copay & Member pay is Copay Only (Cap-Off Allowance of $140 Retail)
V2781 Premium Progressive Plan Pays $110 less applicable member copay & Member pays: Copay PLUS amount over Retail difference of the Std & Prem Progressive at 20% Discount if available. (If Standard/Prem is over $140 Cap-Off Allowance, Member Pays difference over $140 in addition to their Stan Progressive Co-Pay)
Contact Lenses
V2500-V2530 Plan Pays 90% of Member’s Retail Allowance. Member pays balance over allowance
Add-Ons and Upgrades
Materials
V2784 Polycarbonate Patient responsibility less any available discounts by provider
V2783 High Index Patient responsibility less any available discounts by provider
Coatings
V2755 UV Coating Included- Plan Pays $10 (less patient copay)
V2760 Standard scratch resistance coating Included- Plan Pays $10 (less patient copay)
V2745 Solid or Gradient Tint Patient responsibility less any available discounts by provider
V2750 Standard Anti-reflective coating Patient responsibility less any available discounts by provider
V2750 Premium Anti-reflective coating Patient responsibility less any available discounts by provider
V2762 Polarized Patient responsibility less any available discounts by provider
V2744 Transition Patient responsibility less any available discounts by provider
V2799 Edge Coating/Miscellanous Patient responsibility less any available discounts by provider
Other
All other options/Upgrades & non Rx Sun’s Patient responsibility less any available discounts by provider
Other ancillary products/ solutions Patient responsibility less any available discounts by provider
  • I, the provider, agree to the fee schedule listed herein and understand that my signature reflects my agreement to the fully insured plan.