Page 18 - Winsight 2021 Benefit Guide
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Vision plan
The VSP vision plan provides coverage for routine eye exams and pays for all or a portion of the cost of glasses or contact
lenses. You can choose any provider; however, you always save money if you see in-network providers.
Plan Provisions In-Network Out-of-Network
Exam $10 copay Up to $45 off
Materials $25 copay Up to $30-$100 off
Frames $140 allowance plus 20% off balance Up to $70 off
Lenses 100% after material copay $30-$100 (depending on lenses)
Elective Contact Lenses
• Elective $140 Allowance* Up to $105 off
Medically Necessary
Contact Lenses 100% after Material Copay Up to $210 off
Frequency
• Exam 12 Months
• Lenses 12 Months
• Frames 24 Months
• Contact lenses 12 Months
*Allowance for exam, fitting, evaluation, follow-up care and materials
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