Page 10 - 2022 MLB Umpire Benefit Guide Flipbook 1

Vision – VSP

Your vision program, insured by Vision Service Plan (VSP), also offers you two options for coverage, network and
non-network care. This plan provides each covered family member with coverage for eye exams and necessary
corrective lenses, including eyeglasses or contact lenses.

VSP has a large network of member
providers. If you choose to use one of those
providers, you will pay substantially less
than if you go to a provider outside the VSP
network. To locate a VSP participating
provider in your community, call 1-800-877-
7195 or visit the VSP website at
www.vsp.com and click on Find a VSP
Network Doctor.

Refer to the VSP materials in the appendix
for information on plan benefits and
processing out-of-network claims. All out-of-
network vision claims must be submitted
within six months of the date of service.

Vision Plan Benefits Summary

Service In-Network Out-of-Network Reimbursement

Annual Eye Exam $10 Copay Up $50 (copay applies)
Exam: Once Every Calendar Year
Frequency Lenses: Once Every Other Calendar Year
Frames: Once Every Other Calendar Year
Eyeglass Lenses
Single Up to $50 (copay applies)
Bifocal $25 Copay Up to $75 (copay applies)
Trifocal Up to $100 (copay applies)
$25 Copay, $120 Retail
Eyeglass Frames Allowance, 20% discount on Up to $70 (copay applies)
charges over $120
Medically Necessary Contact
Lenses Paid in full Up to $210
Elective Contact Lenses in lieu $120 Allowance Up to $105
of Glasses

Tints, Special Coatings, etc. on Additional Charge, Discounted at N/A
Lenses Network Doctors

Click here for a detailed Vision Plan Summary

Page | 10