Page 15 - 2022 US Benefits Guide FINAL

VISION PLAN

The vision plan provides coverage for routine eye exams and pays for all or a portion of the cost
of glasses or contact lenses. You can choose any provider; however, you always save money if
you see in-network providers. We offer vision through VSP.

Click here to watch a short video with more information on our vision plan.

Vision Plan
Plan Provisions In-Network
Exam $20 copay

$130 allowance
$150 allowance for featured frames
Frames
plus 20% off balance
$70 Walmart or Costco allowance (discount off balance does not apply)
Lenses
 Single Vision Lenses $0 copay
 Bifocal Lenses $90 - $105 allowance
 Trifocal Lenses $150-$175 allowance
Contact Lenses
 Elective $130 allowance
 Medically Necessary Up to a $60 copay for fitting and evaluation
Frequency
 Exam Every 12 months
 Lenses Every 12 months
 Frames Every 24 months

Extra Savings
VSP offers discounts on additional glasses, sunglasses, including lens
enhancements, from any VSP provider within 12 months of your last WellVision
Exam. Laser Vision Correction discounts are also available.

Using in-network vision providers

While you have the option of choosing any provider, you will save money when you use in-
network doctors. VSP only guarantees coverage from VSP network providers.

Call Member Services for out-of-network plan details.

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