Page 19 - 2018 SLU Enrollment
P. 19
Saint Louis University
Vision Vision Insurance
Because symptoms of health conditions often don’t appear until damage Cards
has already occurred, eye exams are a great way to keep tabs on what’s VSP does not provide vision insurance
happening in your body. SLU vision insurance coverage, offered in ID cards. Members are not required
partnership with Vision Service Plan (VSP), is designed to meet a variety to carry or produce a vision card for
services at any of our VSP providers
of needs. ofices. Members simply choose a VSP
provider and let them know they have
Your vision beneits and rates will remain the same for the 2018 plan year. VSP coverage. The doctor’s ofice will
request the name of the member and/
Find an In-Network Provider or patient name, the last 4 digits of
the member’s ID (their SSN), and VSP
Remember to visit in-network providers to receive the deepest level of will take care of the rest.
discount on your services. To ind a participating in-network provider in As an alternative, members can
your area, go to www.vsp.com and select the “choice” network. download a member-speciic ID
card on www.vsp.com if having a
In-Network Out-of-Network
Well Vision Exam physical ID card is preferred.
$10 copay Up to $45 allowance To conirm eligibility in VSP’s system,
Lenses please contact Customer Service at
Single $10 copay Up to $30 allowance 800.877.7195.
Bifocal $10 copay Up to $50 allowance
Trifocal $10 copay Up to $65 allowance
Frames
$150 allowance for a wide Up to $70 allowance
selection of frames; $170
allowance for featured
frame brands; 20%
discount on the amount
over your balance
Contacts
$150 allowance for Up to $105 allowance
contacts; including the
contacts lens exam (itting
and evaluation)
Frequency
Exam, Lenses, Contacts Every calendar year
Frames Every other calendar year
This is a high level summary of your beneit coverage. Full coverage details are available in your
summary plan description (SPD). In the event there is a discrepancy between what is relected in
this guide and what is communicated in your SPD, the terms of your SPD will prevail.
Monthly Premiums Bi-Weekly Premiums
Employee $7.02 $3.24
Employee and Spouse $12.76 $5.89
Employee and Child(ren) $13.38 $6.18
Family $20.66 $9.54
19
Vision Vision Insurance
Because symptoms of health conditions often don’t appear until damage Cards
has already occurred, eye exams are a great way to keep tabs on what’s VSP does not provide vision insurance
happening in your body. SLU vision insurance coverage, offered in ID cards. Members are not required
partnership with Vision Service Plan (VSP), is designed to meet a variety to carry or produce a vision card for
services at any of our VSP providers
of needs. ofices. Members simply choose a VSP
provider and let them know they have
Your vision beneits and rates will remain the same for the 2018 plan year. VSP coverage. The doctor’s ofice will
request the name of the member and/
Find an In-Network Provider or patient name, the last 4 digits of
the member’s ID (their SSN), and VSP
Remember to visit in-network providers to receive the deepest level of will take care of the rest.
discount on your services. To ind a participating in-network provider in As an alternative, members can
your area, go to www.vsp.com and select the “choice” network. download a member-speciic ID
card on www.vsp.com if having a
In-Network Out-of-Network
Well Vision Exam physical ID card is preferred.
$10 copay Up to $45 allowance To conirm eligibility in VSP’s system,
Lenses please contact Customer Service at
Single $10 copay Up to $30 allowance 800.877.7195.
Bifocal $10 copay Up to $50 allowance
Trifocal $10 copay Up to $65 allowance
Frames
$150 allowance for a wide Up to $70 allowance
selection of frames; $170
allowance for featured
frame brands; 20%
discount on the amount
over your balance
Contacts
$150 allowance for Up to $105 allowance
contacts; including the
contacts lens exam (itting
and evaluation)
Frequency
Exam, Lenses, Contacts Every calendar year
Frames Every other calendar year
This is a high level summary of your beneit coverage. Full coverage details are available in your
summary plan description (SPD). In the event there is a discrepancy between what is relected in
this guide and what is communicated in your SPD, the terms of your SPD will prevail.
Monthly Premiums Bi-Weekly Premiums
Employee $7.02 $3.24
Employee and Spouse $12.76 $5.89
Employee and Child(ren) $13.38 $6.18
Family $20.66 $9.54
19
