Blue Cross Blue Shield FEP Vision
Section 6 International Services and Supplies

You may need to pay the provider in-full at the time of service and you will be reimbursed up to the amounts shown below:

Services/Material: Vision Care Exam/Refraction Only Exam
High Option We Pay: Up to $60
Standard Option We Pay: Up to $60

Services/Material: Single Vision Lenses
High Option We Pay: Up to $72
Standard Option We Pay: Up to $72

Services/Material: Bifocal Lenses
High Option We Pay: Up to $109
Standard Option We Pay: Up to $109

Services/Material: Trifocal Lenses
High Option We Pay: Up to $136
Standard Option We Pay: Up to $136

Services/Material: Lenticular Lenses
High Option We Pay: Up to $136
Standard Option We Pay: Up to $136

Services/Material: Contact Lenses
High Option We Pay: Up to $150
Standard Option We Pay: Up to $140

Services/Material: Medically Necessary Contact Lenses
High Option We Pay: Up to $600
Standard Option We Pay: Up to $600

Services/Material: Frames
High Option We Pay: Up to $200
Standard Option We Pay: Up to $140