Page 14 - AFL 2022 Grandfathered Guide with Legal Notices
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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 a vision plan through VSP.
VSP Vision Plan
Plan Provisions In-Network Out-of-Network
Exam $10 copay Up to $50
Frames $150 allowance plus $25 copay Up to $70
Lenses
΅ Single Vision Lenses $0 copay Up to $50
΅ Bifocal Lenses $0 copay Up to $75
΅ Trifocal Lenses $0 copay Up to $100
Contact Lenses
΅ Elective $150 allowance Up to $105
΅ Medically Necessary $0 copay Up to $105
Frequency
΅ Exam Every 12 months Every 12 months
΅ Lenses Every 12 months Every 12 months
΅ Frames Every 24 months Every 24 months
΅ Contact lenses Every 12 months Every 12 months
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