Page 12 - Lanter Delivery Systems 2021 Benefits Guide
P. 12
2020
Find a Vision Provider Vision
Visit in-network providers to receive the deepest discount We partner with VSP to offer you and your family
on your services. To ind an in-network provider, visit members vision insurance. Visit www.vsp.com to ind
www.vsp.com and click “Find a Doctor.” in-network providers and access to a variety of online
tools and programs.
VSP Choice Plan
In-Network Out-of-Network
Vision Exam $10 copay $45 allowance
Lenses $25 copay
Single-Vision Covered in full $30 allowance
Bifocal Covered in full $50 allowance
Trifocal Covered in full $65 allowance
Lenticular Covered in full $100 allowance
Frames $25 copay
$130 allowance $70 allowance
Contact Lenses
Contact Lens Exam Up to $60 copay
Fitting
Instead of Lenses and $130 allowance $105 allowance
Frame
Medically Necessary for Covered in full $210 allowance
Speciic Conditions
Beneit Frequency
Exam 12 months
Lenses 12 months
Frames 24 months
Premium Per Pay Period
Employee $1.30
Employee and Spouse $2.07
Employee and Child(ren) $2.12
Family $3.41
12
Find a Vision Provider Vision
Visit in-network providers to receive the deepest discount We partner with VSP to offer you and your family
on your services. To ind an in-network provider, visit members vision insurance. Visit www.vsp.com to ind
www.vsp.com and click “Find a Doctor.” in-network providers and access to a variety of online
tools and programs.
VSP Choice Plan
In-Network Out-of-Network
Vision Exam $10 copay $45 allowance
Lenses $25 copay
Single-Vision Covered in full $30 allowance
Bifocal Covered in full $50 allowance
Trifocal Covered in full $65 allowance
Lenticular Covered in full $100 allowance
Frames $25 copay
$130 allowance $70 allowance
Contact Lenses
Contact Lens Exam Up to $60 copay
Fitting
Instead of Lenses and $130 allowance $105 allowance
Frame
Medically Necessary for Covered in full $210 allowance
Speciic Conditions
Beneit Frequency
Exam 12 months
Lenses 12 months
Frames 24 months
Premium Per Pay Period
Employee $1.30
Employee and Spouse $2.07
Employee and Child(ren) $2.12
Family $3.41
12
