Page 8 - Guide
P. 8
Please note Walmart Vision
and Sam’s Club are
out-of-network, Because symptoms of health conditions often don’t appear until damage has
however VSP is able already occurred, eye exams are a great way to keep tabs on what’s happening in
to work directly your body. Your eyes are the only place in your body which provide a clear view of
with them for your blood vessels, arteries, and the cranial nerve, which can tell your doctor a lot
reimbursement. about your overall health. Whether you need consistent access to comprehensive
vision insurance or are exploring this beneit for the irst time, our vision insurance
coverage is designed to meet a variety of needs.
No Changes to Plan or Carrier
There are no changes to our vision beneits this year. Vision coverage is offered
through VSP. Please review the additional details provided regarding the plan design
and cost of dental insurance coverage. Keep in mind, the information in the chart
provided is a summary only. Please refer to your summary plan description (SPD)
for complete details of plan beneits, limitations, and exclusions. In the event of a
conlict between the SPD and this description, the terms of the SPD will prevail.
In-Network Out-of-Network
Vision Exam (Once per Calendar Year)
Exam Copay $10 Up to $45
Lenses (Once per Calendar Year)
Single Lens $25 copay Up to $30
Bifocal Lens $25 copay Up to $50
Trifocal Lens $25 copay Up to $65
Frames (Once per Two Calendar Years)
Frame Benefit $25 copay, $130 allowance, Up to $70
20% discount balance over
$130
Contact Lenses (Once per Calendar Year)
Elective $130 allowance Up to $105
Medically Necessary $130 allowance Up to $105
Semi-Monthly Rates
In-Network
Employee Only $3.68
Employee + Spouse $5.89
Employee + Child(ren) $6.01
Employee + Family $9.69
8 ClearChoice
and Sam’s Club are
out-of-network, Because symptoms of health conditions often don’t appear until damage has
however VSP is able already occurred, eye exams are a great way to keep tabs on what’s happening in
to work directly your body. Your eyes are the only place in your body which provide a clear view of
with them for your blood vessels, arteries, and the cranial nerve, which can tell your doctor a lot
reimbursement. about your overall health. Whether you need consistent access to comprehensive
vision insurance or are exploring this beneit for the irst time, our vision insurance
coverage is designed to meet a variety of needs.
No Changes to Plan or Carrier
There are no changes to our vision beneits this year. Vision coverage is offered
through VSP. Please review the additional details provided regarding the plan design
and cost of dental insurance coverage. Keep in mind, the information in the chart
provided is a summary only. Please refer to your summary plan description (SPD)
for complete details of plan beneits, limitations, and exclusions. In the event of a
conlict between the SPD and this description, the terms of the SPD will prevail.
In-Network Out-of-Network
Vision Exam (Once per Calendar Year)
Exam Copay $10 Up to $45
Lenses (Once per Calendar Year)
Single Lens $25 copay Up to $30
Bifocal Lens $25 copay Up to $50
Trifocal Lens $25 copay Up to $65
Frames (Once per Two Calendar Years)
Frame Benefit $25 copay, $130 allowance, Up to $70
20% discount balance over
$130
Contact Lenses (Once per Calendar Year)
Elective $130 allowance Up to $105
Medically Necessary $130 allowance Up to $105
Semi-Monthly Rates
In-Network
Employee Only $3.68
Employee + Spouse $5.89
Employee + Child(ren) $6.01
Employee + Family $9.69
8 ClearChoice
