Page 10 - 2016 Enrollment

Beneits Guide

Vision

Vision Benefits

All beneits eligible employees may purchase vision coverage which
is insured by Vision Service Plan (VSP). Please note that each of

the medical plans cover one vision exam per year. None of the
medical plans cover vision hardware (lenses, frames, contacts, etc.).
Participating vision providers may be located online at www.vsp.com.

Vision—VSP In Network Out of Network
Eye exam $10 copay Up to $50 reimbursement
after $10 copay
Lenses
Single vision $25 copay Up to $50 reimbursement
after $25 copay
Bifocal $25 copay Up to $75 reimbursement
after $25 copay
Trifocal $25 copay Up to $100 reimbursement
after $25 copay
Lenticular $25 copay Up to $125 reimbursement
after $25 copay
Frames $130 allowance for a wide Up to $70 reimbursement
selection of frames; $150 after $25 copay
allowance for featured frame
brands; 20% off amount
over your allowance
Elective contact Materials covered up to Covered up to $105
lenses* $130; up to $60 copay for
contact lens exam
* In lieu of standard lenses and frames

Vision—Frequency
Exams 12 months
Lenses 12 months
Frames 24 months
Contact lenses 12 months

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