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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 Provisions In-Network Out-of-Network
Exam Covered at 100% after $10 copay Up to $45
Frames Up to $130 allowance Up to $70

Lenses
y Single Lenses Covered at 100% after 25 copay Up to $30
y Bifocal Lenses Covered at 100% after 25 copay Up to $50
y Trifocal Lenses Covered at 100% after 25 copay Up to $65
Contact Lenses (Medically necessary) Covered at 100% Up to $210
Elective Contact Lenses (in lieu of glasses) Up to $130 allowance Up to $105

Frequency
y Exam Once every 12 months Once every 12 months
y Lenses Once every 12 months Once every 12 months
y Frames Once every 24 months Once every 24 months
y Contact lenses Once every 12 months Once every 12 months

Register online to print out your insurance card: www.vsp.com.

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