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i 800-877-7195
vsp.com

Vision Plan

A routine eye exam is not only important for correcting vision, but can lead to the detection of
other serious health conditions. We offer employees and their dependents the choice between two
vision benefit plans through the Vision Service Plan (VSP).

IN-NETWORK Basic Plan Buy-Up Plan
Vision Exam $10 Co-pay $10 Co-pay
(every calendar year)
Prescription Glasses $20 Co-pay $20 Co-pay
Frames Plan pays up to $150 (every other calendar year) Plan pays up to $200 (every calendar year)

Lenses Single, Bifocal, Trifocal Plan pays 100% (every calendar year) Plan pays 100% (every calendar year)
Progressive Lenses
Standard $0 Co-pay $0 Co-pay
Premium $95–$105 Co-pay $50 Co-pay
Custom $150–$175 Co-pay $50 Co-pay
Contacts Exam & Fitting Up to $60 Co-pay Up to $60 Co-pay

Prescription Contacts Plan pays up to $150 (every calendar year) Plan pays up to $200 (every calendar year) PHYSICAL WELL-BEING
(instead of glasses)

Eye Care Visit $20 Co-pay $20 Co-pay
Pink Eye, Eye Injury, Dry Eye

Additional Discounts Available Through VSP Providers
• 20% off of the cost of frames that exceeds your allowance.
• 20% savings on additional glasses and sunglasses, including lens enhancements, from any VSP provider within
12 months of your last WellVision Exam.
• Laser Vision Correction: Average 15% off the regular price or 5% off the promotional price (discounts only
available from contracted facilities).

Know Before You Go

To take advantage of the vision plan hardware benefits, please be sure to go to an in-network provider. To find a
participating eye doctor and eyeglass store visit vsp.com.
Many eyeglass stores will mention that they are an out-of-network provider for VSP. This means you will pay full price for
glasses and will be required to submit a claim to VSP for reimbursement. Please note you will not receive the same level of
benefits when the provider is out-of-network.

Primary Eye Care Program

If you have diabetic eye disease, glaucoma or age-related macular degeneration, you can receive your routine eye care
and follow-up medical eye care services from your VSP doctor. You can also receive preventive retinal screenings if you
have diabetes, but don’t show signs of diabetic eye disease—services are covered with just a $20 co-pay per visit.

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