Page 14 - Pump Down Specialist FINAL Benefit Guide 9-1-2024

VSP Vision Option:

Principal (VSP) Vision

VSP Vision 9/1/24 Semi-Monthly (24) Bi-weekly (26) Dependent Information
We offer our employees and eligible dependents
Employee Only $ 0.00 $ 0.00
dental coverage. Children can join or remain on a
Employee + Spouse $ 3.00 $ 2.77 parent’s dental plan until age 26. When a child turns
26, they will lose dental coverage on the last day of
Employee + Child(ren) $ 3.05 $ 2.82
their birth month.
Employee + Family $ 6.67 $ 6.15

VSP Vision Benefits (In-Network) Plan Coverage

Copays:

Exam $10 Copay
Materials $10 Copay

Contacts (standard) Fitting & Evaluation Up to $60 Copay
Frequency: (Based on Date of Service)
Exams Every 12 Months
Lenses Every 12 Months

Frames Every 24 Months
Contact Lenses Every 12 Months (instead of lens/frame)
Standard Lenses:
Single Vision Covered in Full after Materials Copay
Lined Bifocal Covered in Full after Materials Copay
Lined Trifocal Covered in Full after Materials Copay
Progressive (standard) Lenses: $0 Copay

Frames:
Frames Allowance / $0 Copay $150 Retail allowance, 20% off Balance
Contact Lenses in lieu of eye glasses, materials only:

Frequency Every 12 Months
Lens Allowance / $0 Copay $150 Retail allowance
Other Included Discounts:

Tint, Scratch Resistance, Anti-Reflective, UV Coating 30% Discount

Wide selection of frames from Costco/Walmart/Sam's Up to $80 Allowance

NOTE: This is only a brief overview. Please see Benefit Summary and policy for more details.
Website: https://www.Principal life.com/contact-us or Customer Service: VSP: 1-877-814-8970

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