Page 10 - 15NH Intertek

Enrollment
Guide

Vision Vision

We know your eye sight is precious to you so we provide vision beneits
Safety Goggles included in to make sure your trip to the eye doctor is reasonably priced. To locate
Coverage an in-network VSP provider in your area go to www.vsp.com or call
(Safety goggles are in addition 800-877-7195.
to your frames and contacts, not
in lieu of) VSP In-Network Out-of-Network

According to the U.S. Bureau of Labor Vision Exam
Statistics, approximately 60% of people Exam Copay $10 Copay Up to $50
who incur eye injuries at work are Lenses
not wearing proper protective wear. Single Lens $25 Copay Up to $50
You can receive the right protective Bifocal Lens $25 Copay Up to $75
eyewear as part of your vision Trifocal Lens $25 Copay Up to $100
insurance coverage. VSP members
select from the ProTec Eyewear safety Lenticular Lens $25 Copay Up to $125
frames collection. Visit www.vsp.com Frames
for more details. Frame Beneit $150 Allowance Up to $70
Contact Lenses
In lieu of glasses $150 allowance, copay Up to $105
does not apply
Frequency
Exams 12 months
Lens 12 months
Contacts (in lieu of 12 months
glasses)
Frames 24 months

Employee Contributions
Employee $1.47
Employee + 1 $3.27
Employee + 2 + $9.71

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