Page 25 - Skechers 2022 Benefits Guide

VSP VISION* PLAN OVERVIEW
Your vision is important to your overall health. Everyone should receive regular vision care, regardless of whether your vision is 20/20 or less than perfect. Vision Service Plan (VSP) provides affordable, quality vision care through a nationwide network of participating providers.
VISION PLAN
As a benefit-eligible employee, you can enroll in Vision Service Plan (VSP). Under the VSP Vision Plan, you may access care with any VSP Signature Provider or any licensed provider of your choice.
MAXIMIZE YOUR BENEFITS
While you can use any vision provider, you will save when you visit a network provider.
To find participating providers near you, please visit VSP’s website at vsp.com or call 800-877-7195. On the website, please select “Signature” under Doctor Network.
VSP members will have access to participating retail chains like Costco, Optical, ShopKo, Visionworks, Cohen’s, Optyk, & Heartland Vision.
VSP PROVIDERS
Services
Eye Exam Frames
Laser Vision Correction
Contact Lenses
Medically Necessary Elective/Cosmetic Frequency
Eye Exam Lenses/Contacts Frames
Copayment
Basic Lenses
Single Bifocal Trifocal Lenticular
$25 Copay
Up to $175 allowance
15% off retail price or 5% off promotion price. Services provided by Laser Vision Correction Center
Covered in full
Up to $175 allowance
Every 12 months
Every 12 months
Every 12 months
$25 Copay
Covered in full, after exam copay
Covered in full, after exam copay
Covered in full, after exam copay
Covered in full, after exam copay
Up to $50 allowance
Up to $70
N/A
Up to $210
Up to $105
Every 12 months
Every 12 months
Every 12 months
$25 Copay
Up to $50
Up to $75
Up to $100
Up to $125
VISION PLAN CONTRIBUTIONS**
Your Cost Share Shown Below
NON-VSP PROVIDERS
Employee
$3.50
$5.90
$6.20
$10.00
Employee + Spouse/ Domestic Partner
Employee + Child(ren)
Employee + Family
*Available in all US states and Puerto Rico, excluding Hawaii.
**Your cost per paycheck (pre-tax). When you become eligible for the Plan, your benefits become effective on the 31st day of employment and you will be responsible for all per paycheck costs in the pay period in which your 31st day falls. If you become ineligible for the plan, your benefits terminate on
the last day of the month in which you become ineligible, and you will be responsible for all per paycheck costs for the month. Benefits costs are NOT prorated.
2022 BENEFITS 25