Select Plan H1365-001
Maine Counties: Androscoggin, Cumberland, Kennebec, Sagadahoc, York
Eyewear Allowance
- $150 maximum allowance amount
Eye Exams
- Annual Routine Vision Exam—$0 copay
- Non-Routine, Medicare-Covered Exam—$25 copay
Select Plan H1365-005
Maine Counties: Aroostook, Franklin, Hancock, Knox, Lincoln, Oxford, Penobscot, Piscataquis, Somerset, Waldo, Washington
Eyewear Allowance
- $100 maximum allowance amount
Eye Exams
- Annual Routine Vision Exam—$0 copay
- Non-Routine, Medicare-Covered Exam—$40 copay