Page 13 - 2022 CPI Card Benefits Guide

Vision Plan

Coverage is provided through VSP.
Our vision plan provides affordable, quality vision care. Vision care services
and supplies are covered both for in- and out-of-network, your benefits are
greater when you use network providers. Coverage is provided through VSP.

Vision Plan
PARTICIPATING PROVIDER NON-PARTICIPATING PROVIDER
You pay Reimbursement
Cost
Exam $0 Reimbursement up to $45
Covered Services — Lenses
Single Lenses $10 Reimbursement up to $30
Bifocals $10 Reimbursement up to $50
Trifocals $10 Reimbursement up to $65
Frames Up to $150 allowance Reimbursement up to $100
Covered Services — Contacts in lieu of Frames/Lenses
Contacts — Elective Up to $150 allowance Reimbursement up to $105
ADDITIONAL SERVICES — PARTICIPATING PROVIDERS ONLY
Extra $20 to spend on featured frame brands.
20% off unlimited additional pairs of prescription
Additional Materials glasses and/or non-prescription sunglasses
including lens enhancements, if obtained
within 12 months of an exam
Up to 20% discount off laser surgery,
LASIK Coverage including PRK, LASIK, Custom LASIK, and IntraLase
Benefit Frequency
Exams Once every 12 months Once every 12 months
Lenses Once every 12 months Once every 12 months
Frames Once every 12 months Once every 12 months
Contacts Once every 12 months Once every 12 months
(in lieu of glasses)

Why VSP? Click here to learn more.
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