Page 18 - Guide
P. 18
To find a VSP doctor,
visit www.vsp.com or
call 800.877.7195 Vision
Diabetic Eyecare Plus The vision plan is offered through vision service plan (VSP) utilizing the choice
Program network. Just a reminder, there are no ID cards issued for the vision plan. Group
In-network vision services numbers are available on the beneit directory.
related to type 1 and 2
diabetes are available for a Description In-Network Out-of-Network Reimbursement
$20 copay with no frequency WellVision Exam* (Every Calendar Year)
limitations. Ask your VSP Focuses on your eyes and $15 copay Up to $45
provider for details. overall wellness
Frame (Every Other Calendar Year)
$170 allowance + 20% off the $25 copay Up to $70
amount over your balance
Lenses (Every Calendar Year)
Single vision, lined bifocal, and $25 copay Single: up to $30
lined trifocal lenses Lined bifocal: up to $50
Lined trifocal: up to $65
Lens Options (Every Calendar Year)
X Standard progressive X Standard progressive: $55 Up to $50
lenses X Premium progressive:
X Premium progressive $95—$105
lenses X Custom progressive:
X Custom progressive lenses $150—$175
X Average of 20-25% off
other lenses options
Contacts—Instead of glasses (Every Calendar Year)
$150 allowance for contacts, Contacts fitting and evaluation Up to $105
copay does not apply; is covered up to $60
contacts lens exam (fitting and
evaluation)
Discounts available (in-network only): 20% off additional glasses and sunglasses, including lens
options, from any VSP doctor within 12 months of your last WellVision exam. Average of 15% off
the regular price or 5% off the promotional price for laser vision correction at contracted facilities.
Note: frequency is based on a calendar year basis: this means you can get a new exam starting every
January 1, as opposed to 12 months from the date of your last exam.
Contribution Rates
Vision Plan Monthly Employee Contribution
Employee (Ee) $5.84
Ee + spouse $11.67
Ee + child(ren) $12.50
Family $19.96
Hussmann
18 Corporation
visit www.vsp.com or
call 800.877.7195 Vision
Diabetic Eyecare Plus The vision plan is offered through vision service plan (VSP) utilizing the choice
Program network. Just a reminder, there are no ID cards issued for the vision plan. Group
In-network vision services numbers are available on the beneit directory.
related to type 1 and 2
diabetes are available for a Description In-Network Out-of-Network Reimbursement
$20 copay with no frequency WellVision Exam* (Every Calendar Year)
limitations. Ask your VSP Focuses on your eyes and $15 copay Up to $45
provider for details. overall wellness
Frame (Every Other Calendar Year)
$170 allowance + 20% off the $25 copay Up to $70
amount over your balance
Lenses (Every Calendar Year)
Single vision, lined bifocal, and $25 copay Single: up to $30
lined trifocal lenses Lined bifocal: up to $50
Lined trifocal: up to $65
Lens Options (Every Calendar Year)
X Standard progressive X Standard progressive: $55 Up to $50
lenses X Premium progressive:
X Premium progressive $95—$105
lenses X Custom progressive:
X Custom progressive lenses $150—$175
X Average of 20-25% off
other lenses options
Contacts—Instead of glasses (Every Calendar Year)
$150 allowance for contacts, Contacts fitting and evaluation Up to $105
copay does not apply; is covered up to $60
contacts lens exam (fitting and
evaluation)
Discounts available (in-network only): 20% off additional glasses and sunglasses, including lens
options, from any VSP doctor within 12 months of your last WellVision exam. Average of 15% off
the regular price or 5% off the promotional price for laser vision correction at contracted facilities.
Note: frequency is based on a calendar year basis: this means you can get a new exam starting every
January 1, as opposed to 12 months from the date of your last exam.
Contribution Rates
Vision Plan Monthly Employee Contribution
Employee (Ee) $5.84
Ee + spouse $11.67
Ee + child(ren) $12.50
Family $19.96
Hussmann
18 Corporation
