Page 11 - 2021 Dreyer's Benefits Guide

Vision Plan

Healthy eyes and clear vision are an important part of your overall health and quality of life. You may enroll
yourself and your eligible dependents or you may waive vision coverage. You do not have to be enrolled in
medical coverage to elect vision coverage or cover the same dependents under medical and vision.
The table below summarizes the key features of the vision plan. Please refer to the official plan documents
for additional information on coverage and exclusions.

VSP CHOICE PLAN
VSP CHOICE NETWORK IN-NETWORK OUT-OF-NETWORK
COST
Exam $20 copay Up to $45
Materials $0 copay See below
COVERED SERVICES
Single Lenses Up to $30
Bifocals Covered in full after copay Up to $50
Trifocals Up to $65
$130 allowance; 20% off balance
Frames Up to $70
(additional $20 toward featured brands)
Contact Lens: Elective $130 allowance Up to $105
Contact Lens: Medically necessary Covered in full Up to $210
OTHER BENEFITS

LASIK Coverage Average 15–20% off or 5% off Not covered
promotional offer at select providers
BENEFIT FREQUENCY
Examination Once every 12 months
Lenses or Contact Lenses Once every 12 months
Frames Once every 24 months

USING YOUR VSP BENEFITS IS EASY
• Register at www.vsp.com. Once your plan is effective, review your benefit information.
• Find an eye care provider who is right for you. The decision is yours to make.
• Choose a VSP provider or any out-of-network provider. To find a VSP provider, visit www.vsp.com
or call 800-877-7195.
• At your appointment, inform them you have VSP. There is no ID card necessary. If you would like a card
as a reference, you can print one on www.vsp.com.
• That’s it. There are no claim forms to complete when you see a VSP Provider.

Note: Dental and vision plans can be elected separately.

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VISION PLAN