Your Vision Care Benefits
Once each calendar year, the plan covers the following services and supplies up to the annual benefits maximum as shown on the below Summary of Vision Care Plan:
- One routine (“refractive”) annual vision exam per participant. Since the plan has no list of network or PPO providers, you can go to any optometrist or qualified vision care provider for your exam. However, if you get your exam at the Costco Optical Department, your provider will submit the bill for your exam directly to the plan. If you use any other provider, you will have to pay the balance first then submit a Vision Exam Claim Form for reimbursement to Aetna.
- One set of prescription eyewear per person purchased from Costco Optical. The plan covers eyeglasses or contact lenses (including disposable lenses) in lieu of eyeglasses. To purchase your eyewear, simply visit a Costco Optical Department where they will verify your eligibility for coverage. If you are eligible, the plan will pay a once-per-year benefit for your eyewear up to the maximum annual dollar amount shown on the below Summary of Vision Care Plan.
|Summary of Vision Care Plan|
|Service or Supply||Once per year benefit|
|Refraction eye exam||Paid up to $60|
|Eyewear from Costco Optical Department|
|Eyeglasses||Paid up to $150 for frames and lenses combined|
|Contact lenses in lieu of glasses||Paid up to $150|
|Eyewear from Non-Costco Optical Providers (if covered)|
|Eyeglasses||Paid up to $100|
|Contact lenses in lieu of glasses||Paid up to $100|
Note: The plan’s eyewear benefit is payable for only one purchase per year. Therefore even if you do not use the full $150 annual benefit for that purchase, the unused balance will be forfeited.
Non-Costco Optical Providers
The plan will not cover eyewear you purchase from a non-Costco Optical provider except in either of the two following cases:
- If there is no Costco Optical Department with 25 miles of your location, you may purchase your glasses or contact lenses from any qualified optical provider, then submit a Medical Claim Form for reimbursement along with proof of your purchase to Aetna.
- If Costco Optical provides written confirmation that they could not provide the lens or appropriately fitting frames necessary to fill your prescription, you may go to a non-Costco Optical provider for the eyewear you need. To get reimbursed for your cost, you will need to submit your claim along with the letter from Costco Optical to the Benefits Department.