Page 10 - LADACIN 2022-23 Benefit Guide
P. 10
Your Vision
Plan
Your vision plan is provided through Vision Service
Plan (VSP) using the VSP Choice Network. It provides
coverage for routine eye exams and pays for all or a
portion of the cost of glasses or contact lenses. You
can see in- or out-of-network providers; however, you
generally save money if you see in-network providers.
The chart below represents what you pay for each
service.
Benefit In-Network Benefits
Exam $10 copay
Prescription Glasses $25 copay
Frequency
• Exam 12 months
• Lenses 12 months
• Frames 24 months
You pay any cost over:
$150 general allowance
Frames
$170 allowance-for featured frames
20% discount over allowance amount
$80 allowance at Costco
You pay:
Lens Enhancements
Standard progressive $0
Premium progressive $95-$105
Custom progressive $150- $175
Lens includes tints/photochromic at no cost
Elective contact lenses in lieu of Any cost over $150 allowance,
glasses $60 copay applies
You may choose to see a doctor outside of the VSP Choice Network, however your benefits
will be reduced. Contact VSP for coverage details.
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