Page 9 - CPC Behavioral Healthcare 2022 - 2023 Benefits Guide
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VISION PLAN
YOUR VISION COVERAGE
Your vision plan is provided through VSP. It
provides coverage for routine eye exams, and also
pays for all or a portion of the cost of glasses or
contact lenses. You can see In- or Out-of-network
providers, however, keep in mind that you always
save more money if you stay in-network.
Our VSP plan includes national retailers as well as
private practice doctors. To find an in-network
provider, visit www.vsp.com, or call 1-800-877-
7195.
Our Vision plan includes a vision enhancement service that each of your covered family members may select
from. Your participating VSP provider can assist you with accessing this valuable feature. Please note that Costco
does not participate in this program.
• $230 Retail Frame Allowance …or
• Premium Progressive Lenses covered in full …or
• Photochromic/Light Reactive Lenses & Tints covered in full (SunSync Elite included) …or
• Anti-Reflective Lenses covered in full … or
BENEFIT IN-NETWORK OUT-OF-NETWORK
Exam $10 copay $50 allowance
Prescription Glasses $25 copay N/A
Frequency Once every:
• Exams 12 months
• Lenses 12 months
• Frames 12 months
$130 allowance on large selection
Frames $150 allowance on featured brands Up to $70 allowance
20% savings on either allowance
Lenses Up to:
Covered 100%
Single Vision $50 allowance
Covered 100%
Lenses Bifocal $75 allowance
Covered 100%
Lenses Trifocal $100 allowance
Elective Contact Lenses in lieu of Glasses
(Additional copay may apply for the filling and $135 allowance Up to $105 allowance
evaluation of contact lenses)
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