2026 CODAC Benefit Summaries and Carrier Flyers

VISION CARE BENEFITS

The Plan will pay for Covered Expenses for vision care Incurred by a Covered Person, subject to any required Deductible, Copay if applicable, Plan Participation amount, maximums, and limits shown on the Schedule of Benefits. Benefits are based on the Usual and Customary charge or the Negotiated Rate.

COVERED BENEFITS

Eye exam. Refraction.

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EXCLUSIONS

Benefits will NOT be provided for any of the following:

Sunglasses or subnormal vision aids.

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• The fitting and/or dispensing of non-prescription glasses or vision devices, whether or not prescribed by a Physician or optometrist. • Correction of visual acuity or refractive errors. • Aniseikonia. • Lenses. ➢ Single. ➢ Bifocal. ➢ Trifocal. ➢ Lenticular. ➢ Progressive. • Frames. • Elective Contacts. • Contact lens fitting. • Vision therapy services (including orthoptics) or supplies. • Safety lenses and frames. • Eye surgeries used to improve or correct eyesight for refractive disorders, including LASIK surgery, radial keratotomy, refractive keratoplasty, or similar surgery.

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