Page 16 - Yaskawa 2022 Open Enrollment Guide
P. 16
Vision
VSP Vision Plan
Yaskawa America, Inc. ofers a vision plan through VSP. Participating providers include national chains such as
Costco Optical, Eye Care Centers of America Inc., Visionworks, Walmart Vision Center, and many other vision
centers. Please visit www.vsp.com for a complete listing of participating providers.
In-Network Out-of-Network
Eye Exam (every 12 months)
Covered in full after $10 copay $45 copay
Lenses (every 12 months)
Single Lens $30 copay
Bifocal Lens Covered in full after $25 copay $50 copay
Trifocal Lens $65 copay
Lenticular $100 copay
Frames (every 24 months)
Covered in full; basic frame allowance
$150, featured frame allowance $170
(Featured frames include BEBE, Nine West, $70 allowance
Michael Kors, Lacoste, Nike, and more)
Contact Lens Exam and Materials (in lieu of lenses and frame):
After exam and material copay of $10 to Elective: $105
$60, covered in full up to $150 Necessary: $210
Laser VisionCare Program: Discounts average 15–20% of or take 5% of a promotional ofer for laser surgery,
including PRK, LASIK, and Custom LASIK at preferred providers.
Discounts
■ 20% of any amount above the retail frame allowance.
■ 20% of unlimited additional pairs of prescription glasses and/or non-prescription sunglasses.
■ Mail-in rebate savings on eligible Bausch + Lomb contacts and ACUVUE Brand Contact Lenses at
preferred providers.
Bi-Weekly Employee
Contributions
Bi-Weekly Employee Contribution
Employee $0.76
Employee + Spouse $1.22
Employee + Child(ren) $1.24
Family $2.00
* Note 26 annual pay periods
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VSP Vision Plan
Yaskawa America, Inc. ofers a vision plan through VSP. Participating providers include national chains such as
Costco Optical, Eye Care Centers of America Inc., Visionworks, Walmart Vision Center, and many other vision
centers. Please visit www.vsp.com for a complete listing of participating providers.
In-Network Out-of-Network
Eye Exam (every 12 months)
Covered in full after $10 copay $45 copay
Lenses (every 12 months)
Single Lens $30 copay
Bifocal Lens Covered in full after $25 copay $50 copay
Trifocal Lens $65 copay
Lenticular $100 copay
Frames (every 24 months)
Covered in full; basic frame allowance
$150, featured frame allowance $170
(Featured frames include BEBE, Nine West, $70 allowance
Michael Kors, Lacoste, Nike, and more)
Contact Lens Exam and Materials (in lieu of lenses and frame):
After exam and material copay of $10 to Elective: $105
$60, covered in full up to $150 Necessary: $210
Laser VisionCare Program: Discounts average 15–20% of or take 5% of a promotional ofer for laser surgery,
including PRK, LASIK, and Custom LASIK at preferred providers.
Discounts
■ 20% of any amount above the retail frame allowance.
■ 20% of unlimited additional pairs of prescription glasses and/or non-prescription sunglasses.
■ Mail-in rebate savings on eligible Bausch + Lomb contacts and ACUVUE Brand Contact Lenses at
preferred providers.
Bi-Weekly Employee
Contributions
Bi-Weekly Employee Contribution
Employee $0.76
Employee + Spouse $1.22
Employee + Child(ren) $1.24
Family $2.00
* Note 26 annual pay periods
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