Enrollees age 19 and over: No charge; Enrollee pays nothing limited to an Eyeglass frames, lenses (any type), lens options such as Allowance of $150 every 24 months tinting, or prescription contact lenses, contact lens evaluations and examinations associated with their fitting. The benefit After Allowance, Enrollee pays 100% of all charges period begins on the date services are first obtained. The Allowance may be used toward the following in any Contact Lenses or Framed Lenses for Eye combination: Pathology: After Deductible, Enrollee pays nothing • Eyeglass frames • Eyeglass lenses (any type) including tinting and coating • Corrective industrial (safety) lenses • Sunglass lenses and frames when prescribed by an eye care provider for eye protection or light sensitivity • Corrective contact lenses in the absence of eye pathology, including associated fitting and evaluation examinations • Replacement frames, for any reason, including loss or breakage • Replacement contact lenses • Replacement eyeglass lenses Contact lenses or framed lenses for eye pathology when Medically Necessary. One contact lens per diseased eye in lieu of an intraocular lens is covered following cataract surgery provided the Enrollee has been continuously covered by KFHPWA since such surgery. In the event an Enrollee’s age or medical condition prevents the Enrollee from having an intraocular lens or contact lens, framed lenses are available. Replacement of lenses for eye pathology, including following cataract surgery, is covered only once within a 12-month period and only when needed due to a change in the Enrollee’s prescription. Replacement for loss or breakage is subject to the frames and lenses benefit. Frames and Lenses (in lieu of contract lenses): No charge; Enrollee pays nothing for 1 set of frames and Enrollee to age 19: lenses per calendar year Eyeglass frames, lenses (any type), lens options such as tinting, or prescription contact lenses, contact lens evaluations Contact lenses (in lieu of eyeglasses): Enrollee and examinations associated with their fitting. The benefit pays 50% coinsurance period begins on January 1 and continues through the end of the calendar year. The benefit may be used toward contact After benefit is exhausted: Not covered; Enrollee lenses (in lieu of eyeglasses) or 1 eyeglass frame and pair of pays 100% of all charges lenses. • Eyeglass frames Contact Lenses or Framed lenses for Eye • Eyeglass lenses (any type) including tinting and coating Pathology: After Deductible, Enrollee pays nothing • Corrective industrial (safety) lenses • Corrective contact lenses in the absence of eye pathology, including associated fitting and evaluation examinations Contact lenses or framed lenses for eye pathology when Medically Necessary. PEBB_VA_2024 35