Page 12 - RSD Guide
P. 12
Vision
New Benefit Effective August 1, 2015
Vision benefits are essential towards maintaining your overall health and well-being, which is why we are proud
to offer vision coverage.
Beneit Description Copay
Your Coverage with a VSP Doctor
X Focuses on your eyes and overall wellness
WellVision exam $10
X Every 12 months
Prescription Glasses $25
X $130 allowance for a wide selection of frames
X $150 allowance for featured frame brands
Frame Included in prescription glasses
X 20% savings on the amount over your allowance
X Every 24 months
X Single vision, lined bifocal, and lined trifocal lenses
Lenses X Polycarbonate lenses for dependent children Included in prescription glasses
X Every 12 months
X Standard progressive lenses $55
X Premium progressive lenses $95–$105
Lens X Custom progressive lenses $150–$175
enhancements X Average savings of 20-25% on other lens
enhancements
X Every 12 months
X $130 allowance for contacts and contact lens exam
(itting and evaluation)
Contacts (instead of glasses) X 15% savings on a contact lens exam (itting and $0
evaluation)
X Every 12 months
Glasses and Sunglasses
X 20% savings on additional glasses and sunglasses, including lens enhancements, from any
VSP doctor within 12 months of your last WellVision exam
Retinal Screening
Extra savings X No more than a $39 copay on routine retinal screening as an enhancement to a WellVision
exam
Laser Vision Correction
X Average 15% off the regular price or 5% off the promotional price; discounts only available
from contracted facilities
Monthly Vision Vision Provider Search
Contributions 1. Go to www.vsp.com 3. Insert your zip code
Employee $6.67
Employee/spouse $13.34 2. Select “Find a VSP 4. Enter remaining search criteria
Employee/child(ren) $14.29 doctor”
Family $22.82
VSP Doctor Network: VSP Choice
12
2015 Benefit Guide
New Benefit Effective August 1, 2015
Vision benefits are essential towards maintaining your overall health and well-being, which is why we are proud
to offer vision coverage.
Beneit Description Copay
Your Coverage with a VSP Doctor
X Focuses on your eyes and overall wellness
WellVision exam $10
X Every 12 months
Prescription Glasses $25
X $130 allowance for a wide selection of frames
X $150 allowance for featured frame brands
Frame Included in prescription glasses
X 20% savings on the amount over your allowance
X Every 24 months
X Single vision, lined bifocal, and lined trifocal lenses
Lenses X Polycarbonate lenses for dependent children Included in prescription glasses
X Every 12 months
X Standard progressive lenses $55
X Premium progressive lenses $95–$105
Lens X Custom progressive lenses $150–$175
enhancements X Average savings of 20-25% on other lens
enhancements
X Every 12 months
X $130 allowance for contacts and contact lens exam
(itting and evaluation)
Contacts (instead of glasses) X 15% savings on a contact lens exam (itting and $0
evaluation)
X Every 12 months
Glasses and Sunglasses
X 20% savings on additional glasses and sunglasses, including lens enhancements, from any
VSP doctor within 12 months of your last WellVision exam
Retinal Screening
Extra savings X No more than a $39 copay on routine retinal screening as an enhancement to a WellVision
exam
Laser Vision Correction
X Average 15% off the regular price or 5% off the promotional price; discounts only available
from contracted facilities
Monthly Vision Vision Provider Search
Contributions 1. Go to www.vsp.com 3. Insert your zip code
Employee $6.67
Employee/spouse $13.34 2. Select “Find a VSP 4. Enter remaining search criteria
Employee/child(ren) $14.29 doctor”
Family $22.82
VSP Doctor Network: VSP Choice
12
2015 Benefit Guide
