Network Benefits:

Benefits for Vision Care Services are determined based on the negotiated contract fee between the Company and the Vision Care Provider. The Company’s negotiated rate with the Vision Care Provider is ordinarily lower than the Vision Care Provider's billed charge.


Non-Network Benefits:

Benefits for Vision Care Services from non-Network providers are determined as a percentage of the provider's billed charge.


Out-of-Pocket Maximum:

Any amount the Insured Person pays in Coinsurance/Co-payments for Vision Care Services under this endorsement applies to the Out-of-Pocket Maximum stated in the Policy Schedule of Benefits.


Policy Deductible:

Benefits for pediatric Vision Care Services provided under this endorsement are not subject to any Policy Deductible stated in the Policy Schedule of Benefits. Any amount the Insured Person pays in Co-payments for Vision Care Services under this endorsement does not apply to the Policy Deductible stated in the Policy Schedule of Benefits.


Usual and Customary Fee :

Usual and Customary Fees are calculated by the Company based on available data resources of competitive fees in that geographic area.


Preferred Allowance:

The amount a Preferred Provider will accept as payment in full for Covered Medical Expenses.