Page 11 - 2017-18 Optimas Benefits Guide
P. 11
Vision Please note: the frames/contacts
We partner with VSP to offer you and your family members vision allowance is reduced to $70 in the
Base Plan and $100 in the Buy-Up
insurance. We offer a base and buy-up option to meet a variety of needs. Plan when you purchase frames or
Please note, ID cards are not needed with VSP. You will simply contacts from Walmart, Sam’s Club,
identify yourself as a VSP member and your doctor will do the rest! or Costco.
If you prefer to have an ID card, you can access your card on vsp.com or
from your smartphone at mobile.vsp.com.
Find an In-Network Provider
Visit in-network providers to receive the deepest level of discount on your
services. To ind a participating in-network provider, go to www.vsp.com
or call 800.877.7195.
VSP
Base Plan Base Plan Buy-Up Plan In- Buy-Up Plan
In-Network Out-of- Network Out-of-
Network* Network*
Exam $20 copay Reimbursed $20 copay Reimbursed
up to $45 up to $45
Materials $20 copay Varies $20 copay Varies
Lenses
Single $20 copay Reimbursed $20 copay Reimbursed
up to $30 up to $30
Bifocal $20 copay Reimbursed $20 copay Reimbursed
up to $50 up to $50
Trifocal $20 copay Reimbursed $20 copay Reimbursed
up to $65 up to $65
Lenticular $20 copay Reimbursed $20 copay Reimbursed
up to $100 up to $100 Base Plan
Frames Weekly Bi- Monthly
$20 copay; up to Reimbursed $20 copay; up to Reimbursed Weekly
$130 allowance, up to $70 $180 allowance, up to $70 Employee $1.11 $2.21 $4.79
30% off of balance 30% off of balance Employee + $1.77 $3.54 $7.67
over allowance over allowance Spouse
at participating at participating Employee + $1.81 $3.61 $7.83
providers providers Child(ren)
Contacts Family $2.91 $5.83 $12.63
Elective $20 copay; up to Reimbursed $20 copay; up to Reimbursed
$130 allowance up to $105 $150 allowance up to $105
Medically $20 copay; covered Reimbursed $20 copay; Reimbursed Buy-Up Plan
Necessary in full up to $210 covered in full up to $210 Weekly Bi- Monthly
Frequency Weekly
$7.99
Exam 12 months Employee $1.84 $3.69 $12.78
$5.90
Employee + $2.95
Lenses 12 months Spouse
Contacts (in 12 months Employee + $3.01 $6.02 $13.05
lieu of glasses) Child(ren)
Frames 24 months 12 months Family $4.86 $9.71 $21.04
* Please note, frequency is the same as in the buy-up plan in-network
This is a high level summary of your beneit coverage. Full coverage details are available in your Optimas 11
summary plan description (SPD). In the event there is a discrepancy between what is relected in
this guide and what is communicated in your SPD, the terms of your SPD will prevail.
We partner with VSP to offer you and your family members vision allowance is reduced to $70 in the
Base Plan and $100 in the Buy-Up
insurance. We offer a base and buy-up option to meet a variety of needs. Plan when you purchase frames or
Please note, ID cards are not needed with VSP. You will simply contacts from Walmart, Sam’s Club,
identify yourself as a VSP member and your doctor will do the rest! or Costco.
If you prefer to have an ID card, you can access your card on vsp.com or
from your smartphone at mobile.vsp.com.
Find an In-Network Provider
Visit in-network providers to receive the deepest level of discount on your
services. To ind a participating in-network provider, go to www.vsp.com
or call 800.877.7195.
VSP
Base Plan Base Plan Buy-Up Plan In- Buy-Up Plan
In-Network Out-of- Network Out-of-
Network* Network*
Exam $20 copay Reimbursed $20 copay Reimbursed
up to $45 up to $45
Materials $20 copay Varies $20 copay Varies
Lenses
Single $20 copay Reimbursed $20 copay Reimbursed
up to $30 up to $30
Bifocal $20 copay Reimbursed $20 copay Reimbursed
up to $50 up to $50
Trifocal $20 copay Reimbursed $20 copay Reimbursed
up to $65 up to $65
Lenticular $20 copay Reimbursed $20 copay Reimbursed
up to $100 up to $100 Base Plan
Frames Weekly Bi- Monthly
$20 copay; up to Reimbursed $20 copay; up to Reimbursed Weekly
$130 allowance, up to $70 $180 allowance, up to $70 Employee $1.11 $2.21 $4.79
30% off of balance 30% off of balance Employee + $1.77 $3.54 $7.67
over allowance over allowance Spouse
at participating at participating Employee + $1.81 $3.61 $7.83
providers providers Child(ren)
Contacts Family $2.91 $5.83 $12.63
Elective $20 copay; up to Reimbursed $20 copay; up to Reimbursed
$130 allowance up to $105 $150 allowance up to $105
Medically $20 copay; covered Reimbursed $20 copay; Reimbursed Buy-Up Plan
Necessary in full up to $210 covered in full up to $210 Weekly Bi- Monthly
Frequency Weekly
$7.99
Exam 12 months Employee $1.84 $3.69 $12.78
$5.90
Employee + $2.95
Lenses 12 months Spouse
Contacts (in 12 months Employee + $3.01 $6.02 $13.05
lieu of glasses) Child(ren)
Frames 24 months 12 months Family $4.86 $9.71 $21.04
* Please note, frequency is the same as in the buy-up plan in-network
This is a high level summary of your beneit coverage. Full coverage details are available in your Optimas 11
summary plan description (SPD). In the event there is a discrepancy between what is relected in
this guide and what is communicated in your SPD, the terms of your SPD will prevail.
