Page 18 - 2022 Benegit Guide

Vision Coverage

Nearly all your vision needs from eye exams to glasses and contact lenses are covered through the vision
plan, administered by VSP through their Choice network. You can choose any eye care provider, but to receive
maximum coverage, visit a VSP provider. When you visit an out-of-network provider, you receive reimbursement
up to a preset amount. For a list of providers in your area, contact VSP at 1-800-877-7195 or vsp.com.

Benefit Plan Features In-Network Non-Network
Eye Exams—one per $10 copay (you may have to pay more $10 copay; reimbursement
12 months for a contact lens exam) up to $45
$20 copay for single vision, lined Bifocal Reimbursement from
Lenses—one set per or lined Trifocal lenses. The copay for $30 to $100, depending
12 months (Polycarbonate progressive lenses and most options is on type of lens
lenses are covered)
variable so ask your eye care provider.
$20 copay for basic frames with a Retail: Up to $70
Frames—one pair every price under $155, plus 20% discount reimbursement
24 months
on the price over $155 Wholesale: Not covered
Contact Lenses—instead 15% discount on the contact lens Reimbursement up to
of glasses, once every exam and no cost for contact $105 or $210 if
12 months lenses up to $130 medically necessary
ID cards not required—Give your VSP ID cards not required—
ID Cards and Claims provider your social security number Pay bill and submit to VSP
for reimbursement
Additional Discounts 15% off Laser Vision Services N/A
Lens Enhancement Discount Average 20-25% savings N/A

Vision coverage becomes a company paid benefit if you are enrolled in an SSC medical plan, however, you
must elect coverage. If you are not enrolled in medical, you may elect and pay for the vision plan separately.

Your Weekly Cost for Coverage Vision Coverage
Team Member $1.27
Team Member + Child(ren) $2.07

Team Member + Spouse $2.03
Team Member + Family $3.34

18 2022 Health and Benefits Guide