Vision Benefits

Vision insurance offers coverage for the routine care of your eyes and may provide coverage for eyeglasses and contact lenses. Your plan will pay for these services based upon the schedule below. Be sure to check your plan certificate for details.

Keep in mind that your costs will generally be lower if you choose an in-network eye-doctor. To find an in-network eye-doctor, please visit www.vsp.com.

VSP Choice Network Benefit	Description	Copay
WELLVISION EXAM	-Focuses on your eyes and overall wellness -Routine retinal screening -Every calendar year	$10 Copay Up to $39
ESSENTIAL MEDICAL EYE CARE	-Retinal imaging for members with diabetes covered-in-full -Additional exams and services beyond routine care to treat immediate issues from pink eye to sudden changes in vision or to monitor ongoing conditions such as dry eye, diabetic eye disease, glaucoma, and more. -Coordination with your medical coverage may apply. Ask your VSP network doctor for details. -Available as needed	$20 per exam
PRESCRIPTION GLASSES		$25
FRAMES	-$170 Featured Frame Brands allowance -$150 frame allowance -20% savings on the amount over your allowance -$150 Walmart/Sam's Club frame allowance -$80 Costco frame allowance -Every other calendar year	Included in Prescription Glasses
LENSES	-Single vision, lined bifocal, and lined trifocal lenses -Impact-resistant lenses for dependent children -Every calendar year	Included in Prescription Glasses
LENS ENHANCEMENTS	-Standard progressive lenses -Premium progressive lenses -Custom progressive lenses -Average savings of 30% on other lens enhancements -Every calendar year	$0 $95-$105 $150-$175
CONTACTS (INSTEAD OF GLASSES)	-$150 allowance for contacts; copay does not apply -Contact lens exam (fitting and evaluation) -Every calendar year	Up to $60
ADDITIONAL SAVINGS	Glasses and sunglasses -Discover all current eyewear offers and savings at vsp.com/offers -20% savings on unlimited additional pairs of prescription or non-prescription glasses/sunglasses, including lens enhancements, from a VSP provider within 12 months of your last WellVision Exam. Laser Vision Correction -Average of 15% off the regular price; discounts available at contracted facilities. Exclusive Member Extras and VSP Members -Contact lens rebates, lens satisfaction guarantees, and more offers at vsp.com/offers. -Save up to 60% on digital hearing aids with TruHearing®. Visit vsp.com/offers/special-offers/hearing-aids for details. -Enjoy everyday savings on health, wellness, and more with VSP Simple Values.
YOUR COVERAGE GOES FURTHER IN-NETWORK	With so many in-network choices, VSP makes it easy to get the most out of your benefits. You’ll have access to preferred private practice, retail, and online in-network choices. Log in to vsp.com to find an in-network provider.

Monthly Premium	Employee Pays
Individual	$8.38
Individual + Spouse	$16.72
Individual + Child(ren)	$17.89
Family	$28.61

Downloads

Summary of Benefits

Keep in mind that your costs will generally be lower if you choose an in-network eye-doctor. To find an in-network eye-doctor, please visit www.vsp.com.

VSP Choice Network Benefit	Description	Copay
WELLVISION EXAM	-Focuses on your eyes and overall wellness -Routine retinal screening -Every calendar year	$10 Copay Up to $39
ESSENTIAL MEDICAL EYE CARE	-Retinal imaging for members with diabetes covered-in-full -Additional exams and services beyond routine care to treat immediate issues from pink eye to sudden changes in vision or to monitor ongoing conditions such as dry eye, diabetic eye disease, glaucoma, and more. -Coordination with your medical coverage may apply. Ask your VSP network doctor for details. -Available as needed	$20 per exam
PRESCRIPTION GLASSES		$25
FRAMES	-$220 Featured Frame Brands allowance -$200 frame allowance -20% savings on the amount over your allowance -$200 Walmart/Sam's Club frame allowance -$110 Costco frame allowance -Every other calendar year	Included in Prescription Glasses
LENSES	-Single vision, lined bifocal, and lined trifocal lenses -Impact-resistant lenses for dependent children -Every calendar year	Included in Prescription Glasses
LENS ENHANCEMENTS	-Standard progressive lenses -Premium progressive lenses -Custom progressive lenses -Anti-glare coating -Average savings of 40% on other lens enhancements -Every calendar year	$0 $80-$90 $120-$160 $40
CONTACTS (INSTEAD OF GLASSES)	-$180 allowance for contacts; copay does not apply -Contact lens exam (fitting and evaluation) -Every calendar year	Up to $60
VSP LIGHTCARE	-$200 allowance for ready-made non-prescription sunglasses, or ready-made non-prescription blue light filtering glasses, instead of prescription glasses or contacts -Every calendar year	$25
ADDITIONAL SAVINGS	Glasses and sunglasses -Discover all current eyewear offers and savings at vsp.com/offers -30% savings on unlimited additional pairs of prescription or non-prescription glasses/sunglasses, including lens enhancements, from a VSP provider on the same day as your WellVision Exam. Or get 20% savings from a VSP provider within 12 months of your last WellVision Exam. Laser Vision Correction -Average of 15% off the regular price; discounts available at contracted facilities. Exclusive Member Extras and VSP Members -Contact lens rebates, lens satisfaction guarantees, and more offers at vsp.com/offers. -Save up to 60% on digital hearing aids with TruHearing®. Visit vsp.com/offers/special-offers/hearing-aids for details. -Enjoy everyday savings on health, wellness, and more with VSP Simple Values.

Monthly Premium	Employee Pays
Individual	$12.03
Individual + Spouse	$24.02
Individual + Child(ren)	$25.69
Family	$41.10

Downloads

Summary of Benefits

Group Number

30052141

Provided By

VSP

Provider Website

www.vsp.com

Customer Service

800.877.7195