Frame Brochure for Michigan Plans, including: Michigan ... · Jazz Capri Optics Metal ... Frames will be shipped with Side Shields attached. ... Capri Optics Download Burgundy Brown

Frame Brochure

for Michigan Plans, including:

Michigan Medicaid

Care Resources

McLaren Health Plan

Meridian Health Plan of Michigan

NVA Michigan Complete Health

Priority Health

UPHP

Effective March 1, 2018

Revised March 14, 2018

Classic Optical Laboratories, Inc. 3710 Belmont Avenue

Youngstown, OH 44505 (888) 522-2020

FAX: (888) 522-2022 www.classicoptical.com

Frame ListWomen

Frame Name Manufacturer Type

7713 Capri Optics Metal

Aries (Unisex) Modern Optical Metal

Beth Modern Optical Metal

Blvd 4154 (Unisex) Hart Specialties Metal

Bria Modern Optical Metal

Certain Modern Optical Zyl

Chill Modern Optical Zyl

Cosmo Modern Optical Zyl

Dazzle Modern Optical Metal

Download Capri Optics Zyl

Eileen Modern Optical Zyl

Finale Modern Optical Metal

Launch Modern Optical Zyl

Lilac Capri Optics Metal

Lindsay Capri Optics Zyl

Lisa Modern Optical Metal

Monica Modern Optical Zyl

Online Capri Optics Zyl

Parallel Modern Optical Zyl

Pixie Modern Optical Zyl

PT 80 Capri Optics Metal



Sheer Modern Optical Zyl

Tiffany Capri Optics Zyl

U 202 Capri Optics Zyl

Upload Capri Optics Zyl

US 53 Capri Optics Zyl






VP 131 Capri Optics Zyl/Metal

Effective 3/01/2018 Michigan Frame Brochure Page 1 of 30 Pages

Frame List

Men


314 Limited Editions Metal




Dillon Modern Optical Zyl

Doug Modern Optical Metal

Exclusive 120 COI Metal

Hunter Modern Optical Metal

Ivy Capri Optics Metal

Jazz Capri Optics Metal


Online Capri Optics Zyl




Tomorrow Modern Optical Zyl

Tony Limited Editions Zyl

Slick Modern Optical Zyl


UM 70 Capri Optics Zyl






Frame List

Children




Bria Modern Optical Metal

Care Modern Optical Zyl

Cheerful Modern Optical Metal



Download Capri Optics Zyl

Downtown (Unisex) Limited Editions Zyl

Dynamite Modern Optical Metal


Lindsay Capri Optics Zyl

Lollipop (Cable) Modern Optical Metal

Manhattan Limited Editions Zyl

Mainstreet 415 Hart Specialties Zyl

Ninja Modern Optical Metal


Pixie Modern Optical Zyl



Pumpkin (Cable/ Skull) Modern Optical Metal

Sheer Modern Optical Zyl

Student Capri Optics Zyl

T 27 Capri Optics TR90



Tweet Capri Optics Zyl


Upload Capri Optics Zyl









Frame List

Children


Wiggle Modern Optical Zyl

Wow Modern Optical Zyl


Frame List

Special Needs - Prior Authorization Required

* NOTE - Special Needs Frames Not Available for NVA Fidelis SecureCare & Health Link


Model 1 Specs4us Titanium













Safety

In Compliance with Michigan Medicaid Requirements, Frames will be shipped with Side Shields attached.


071 On Guard

Metal w/ Removable

Side Shields

071P On Guard

Metal w/ Permanent

Side Shields

093 On Guard

Metal w/ Removable

Side Shields

093P On Guard

Metal w/ Permanent

Side Shields

70F Titmus

Zyl w/ Removable

Side Shields

SL920 Hudson

Zyl w/ Removable

Side Shields

SL921PC/SL921PS Hudson

Zyl w/ Permanent

Side Shields

SL5 Hudson

Metal w/ Removable

Side Shields


Women

Manufacturer Style and Sizes Photo Colors

Capri Optics 7713 Black

Coffee

49-19-140 Gunmetal

52-19-145

Modern Optical Aries Gold

(Unisex) Brown

48-20-140 Gunmetal

50-20-145

Hart Specialties Blvd 4154 Matte Brown

(Unisex) Antique Silver

47-18-135 Shiny Gold

50-18-140

Modern Optical Beth Antique Silver

Gold

50-18-135 Matte Brown

52-18-140 Rose

Modern Optical Bria Brown

Lilac

53-16-135 Rose

Michigan Medicaid Frame Brochure


Women



Modern Optical Certain Black/Lime

Brown

48-18-130 Burgundy

50-18-135

Modern Optical Chill Black/Blue

Black/Lilac

51-17-140 Black/Lime

Black/Orange

Black/Pink

Black/Purple

Black/Red

Black/White

Black/Turquoise

Modern Optical Cosmo Black

Brown Fade

48-20-145 Gray Fade

50-20-150

50-22-150

52-22-150

52-24-150

54-22-150

54-24-150

Modern Optical Dazzle Brown

Rose

49-20-135 Gold

51-20-140

53-20-145

Capri Optics Download Burgundy

Brown

49-18-135 Blue


Women



Modern Optical Eileen Black/Crystal

Brown/Crystal

56-17-140 Burgundy/Pink

Modern Optical Finale Antique Brown

Antique Silver

48-19-135 Gold

50-19-140

52-19-145

Modern Optical Launch Matte Black/Grey

Matte Black/Red

51-18-140 Matte Black/White

Capri Optics Lilac Coffee

Demi Amber

49-18-130 Gold/Silver

51-18-135

Capri Optics Lindsay Black

Burgundy

52-19-135 Brown

54-19-140


Women



Modern Optical Lisa Brown

Rose

52-17-135 Violet

55-17-140

Modern Optical Monica Brown

Grey

50-17-130 Rose

52-17-135

54-17-140

Capri Optics Online Black

Brown

53-17-145 Tortoise

Modern Optical Parallel Blue Fade

Burgundy Fade

53-20-145 Grey Fade

Modern Optical Pixie Black/Crystal

Brown/Crystal

48-16-130 Plum/Crystal


Women



Capri Optics PT 80 Plum

Brown

51-18-135 Antique Pewter

53-18-140

Capri Optics PT 90 Gold

Burgundy

50-18-130 Purple

53-18-135

Capri Optics PT 93 Burgundy

Purple

52-17-135 Brown

Modern Optical Sheer Black/Blue

Black/Mint

51-15-140 Black/Violet

Capri Optics Tiffany Black

Burgundy

49-16-135 Brown

52-16-140


Women



Capri Optics U 202 Black

Brown

49-16-125 Tortoise

53-16-145

Capri Optics Upload Black

Brown

47-18-135 Navy

50-18-140

Capri Optics US 53 Black Crystal

Brown Crystal

51-19-140 Wine

Capri Optics US 56 Grey

Brown

51-18-135 Tortoise

Capri Optics US 59 Black

Brown

53-16-135 Black Tortoise

56-16-140


Women




Brown

52-18-140 Grey


Brown

53-18-145 Tortoise

55-18-150


Purple

51-17-135 Brown

53-17-140 Wine

Capri Optics VP 131 Gold/Black

Gunmetal/Black

51-18-145 Gold/Tortoise


Men

Manufacturer Style Name Photo Colors

Limited Editions 314 Antique Gold

Antique Brown



Coffee

49-19-140 Gunmetal

52-19-145


Black/Lilac


Black/Orange

Black/Pink

Black/Purple

Black/Red

Black/White

Black/Turquoise


Brown Fade

48-20-145 Gray Fade

50-20-150

50-22-150

52-22-150

52-24-150

54-22-150

54-24-150



Men



Modern Optical Dillon Black

Brown Fade

50-19-140 Grey Fade

52-19-145

54-19-150

Modern Optical Doug Antique Brown

Antique Silver

52-20-140 Gold

54-20-145

56-20-145

COI Exclusive 120 Brown

Matte Gold

53-18-140 Silver

55-18-145

Modern Optical Hunter Matte Brown

Gold

53-16-140 Gunmetal

55-16-145

58-16-150

Capri Optics Ivy Black

Gold

54-18-135 Gunmetal

56-18-140

58-18-145


Men



Modern Optical Jazz Black

Brown

52-18-140 Gunmetal

54-18-145

56-18-150

58-18-155

60-18-155


Matte Black/Red


Capri Optics Online Black

Brown

53-17-145 Tortoise


Burgundy Fade

53-20-145 Grey Fade

Capri Optics PT 48 Black/Gold

Gold

54-19-140 Gunmetal

56-19-145

60-19-150


Men



Capri Optics PT 92 Black

Gunmetal

54-18-145 Brown

57-18-150

Modern Optical Slick Black

Tortoise

49-17-135 Red

51-17-140 White

54-17-145

57-17-150

60-17-150

Modern Optical Tomorrow Black

Brown

51-17-135 Grey

53-17-140

55-17-145

Limited Editions Tony Amber

Black/Crystal

52-17-140 Grey


Brown

49-16-125 Tortoise

53-16-145


Men



Capri Optics UM 70 Black

Brown

52-22-140 Grey

54-22-145


Brown


56-16-140


Brown

52-18-140 Grey


Brown

53-18-145 Tortoise

55-18-150


Gunmetal/Black



Children



Coffee

49-19-140 Gunmetal

52-19-145

Capri Optics 7731 Blue

Green

42-18-125

Modern Optical Bria Brown

Lilac

53-16-135 Rose

Modern Optical Care Black/Crystal

Navy/Crystal

42-15-125 Pink/Crystal

44-15-130 Purple/Crystal

46-15-135

Modern Optical Cheerful Demi Amber

Black

40-18-120 Brown

42-18-125 Gold

44-18-130 Pink



Children




Black/Lilac


Black/Orange

Black/Pink

Black/Purple

Black/Red

Black/White

Black/Turquoise


Brown Fade

48-20-145 Gray Fade

50-20-150

50-22-150

52-22-150

52-24-150

54-22-150

54-24-150

Capri Optics Download Burgundy

Brown

49-18-135 Blue

Limited Editions Downtown Black

(Unisex) Burgundy

48-18-140 Midnight Blue

Tortoise

Modern Optical Dynamite Black

Silver

42-18-130 Antique Brown

45-18-135

47-18-140


Children




Matte Black/Red


Capri Optics Lindsay Black

Burgundy

52-19-135 Brown

54-19-140

Modern Optical Lollipop Antique Brown

(Cable) Demi Amber

39-20-130 Rose

41-20-135

43-20-140

Limited Editions Manhattan Blue

Brown

50-17-140 Rose

Not recommended for powers over +3.00

Hart Specialties Mainstreet 415 Blue

Brown

33-20-115 Pink

36-20-120

39-20-125


Children



Modern Optical Ninja Matte Blue

Matte Brown

44-18-130 Matte Burgundy

46-18-135 Violet

Black


Burgundy Fade

53-20-145 Grey Fade

Modern Optical Pixie Black/Crystal

Brown/Crystal

48-16-130 Plum/Crystal

Capri Optics PT 80 Plum

Brown


53-18-140

Capri Optics PT 84 Black

Brown

42-17-125 Blue

45-17-130

48-19-135


Children



Modern Optical Pumpkin Black

Cable Blue

40-16-130 Antique Brown

42-16-135 Gold

Skull

40-16-120

42-16-125

Modern Optical Sheer Black/Blue

Black/Mint

51-15-140 Black/Violet

Capri Optics Student Black

Brown

46-18-130 Tortoise

48-18-135

Capri Optics T 27 Burgundy

Denim

37-15-120 Pink

Capri Optics T 28 Black

Brown

42-15-125 Blue


Children



Capri Optics T 30 Black

Brown

48-16-125 Grey

Capri Optics Tweet Black

Brown

42-15-125 Pink

45-15-130 Red

Navy


Brown

49-16-125 Tortoise

53-16-145

Capri Optics Upload Black

Brown

47-18-135 Navy

50-18-140

Capri Optics US 53 Black Crystal

Brown Crystal

51-19-140 Wine


Children




Brown


56-16-140

Capri Optics US 63 Blue

Burgundy/Pink

46-13-125 Black/Purple


Brown

53-18-145 Tortoise

55-18-150


Purple

51-17-135 Brown

53-17-140 Wine


Purple

44-16-130 Pink


Children




Gunmetal/Black


Modern Optical Wiggle Black

Brown

40-16-120 Purple

42-16-125

44-16-130

Modern Optical Wow Black/lime

Brown

49-16-135 Burgundy/Grey

51-16-140


Special Needs - Prior Authorization Required*NOTE - Special Needs Frames Not Available for NVA Fidelis SecureCare & Health Link


Specs4us Model 1 Brown

Pink

35-16-105 Navy

38-16-110 Violet

40-16-110

43-18-120

Specs4us Model 2 Pink

Violet

40-16-110 Wine

43-16-120

46-18-125

Specs4us Model 3

Eye Sizes 38, 40, 43,

46

Blue Demi

38-16-110 Light Green

40-16-110 Lilac

43-18-120

46-18-125 Eye Sizes 43, 46

Light Blue

Specs4us Model 4 Green Dark

Gunmetal Light

41-16-115 Pink

43-16-120 Pink Demi

46-18-125 Navy

Specs4us Model 5 Black Demi

Brown/Silver Matte

48-18-125 Green Dark

51-18-125 Gunmetal Light






Specs4us Model 6 Eye Size 33

Brown

33-15-110 Pink

35-16-105

38-16-110 Eye Sizes 35, 38, 41

41-16-115 Blue Demi

Brown

Lt. Gun

Pink


Navy

42-16-120 Red

45-16-120 Violet Dark

48-20-125


Brown/Silver Matte

43-16-120 Gold Demi

46-18-125 Navy

Orange/SilverMattte

Specs4us Model 9

Eye Sizes 35, 38, 40,

43

Dark Green

35-16-105 Dark Gunmetal

38-16-110 Pink Demi

40-16-110 Wine

43-16-120

46-18-125 Eye Sizes 38, 43

48-18-125 Navy

Eye Sizes 46, 48

Aqua

Blue

Brown/Silver

Antique Pink





Specs4us Model 11 Eye Sizes 38, 40, 43

Brown

38-16-105 Black Shiny

40-17-120 Bright Blue

43-17-120 Wine

Eye Sizes 40, 43

Dark Violet

Specs4us Model 12 Black/Gun Dark

Brown Med/Dark

46-18-120 Wine Matte

48-18-125 Dark Violet

Specs4us Model 13

Eye Sizes 43, 46, 48,

51

Matte Brown

43-20-120 Green Dark

46-20-125 Wine Matte

48-22-130

51-22-130 Eye Sizes 46, 48, 51

Shiny Black

Specs4us Model 14 Brown/Silver Matte

Navy

43-18-120 Violet

46-20-125

48-20-130


Safety


On Guard 071 Gold

Gunmetal

52-18-140

54-18-140

56-18-140

58-18-140

FRAME COMES WITH REMOVABLE SIDE SHIELDS

In Compliance with Michigan Medicaid Requirements

Frames will be shipped with Side Shields attached

On Guard 071P Gold

Gunmetal

52-18-140

54-18-140

56-18-140

58-18-140

FRAME COMES WITH PERMANENT SIDE SHIELDS

On Guard 093 Gold

Gunmetal

48-21-135

50-21-135




On Guard 093P Gold

Gunmetal

48-21-135

50-21-135




Safety



Titmus 70F Gray

(Side Shield CS77) Black

48-20-140

48-22-145

48-24-145


50-22-150 In Compliance with Michigan Medicaid Requirements

50-24-155 Frames will be shipped with Side Shields attached

Hudson SL920 Brown

(Side Shield SS-92) Charcoal

55-16-145

58-16-150




Hudson SL921PC Brown

SL921PS Charcoal

55-16-145

58-16-150


Hudson SL5 Brown

Burgundy

50-16-145

53-16-150





Documents

Frame Brochure for Michigan Plans, including: Michigan ... · Jazz Capri Optics Metal ... Frames will be shipped with Side Shields attached. ... Capri Optics Download Burgundy Brown