Page 11 - 2019 Heico Core Benefits Guide
P. 11
2019 | The Heico Companies Enrollment Guide
Vision Plan
VSP
Heico offers a vision plan through Vision Service Plan (VSP) utilizing their Signature Plan Network� Please visit www.vsp.com for a
complete listing of participating providers in-network�
VSP Plan Design In-Network Out-of-Network
Eye Exam (every 12 months) $25 copay $50 allowance after $25 copay
Lenses (every 12 months)
Single Lens $50 copay $50 allowance after $50 copay
Lined Bifocal Lens $50 copay $75 allowance after $50 copay
Lined Trifocal Lens $50 copay $100 allowance after $50 copay
Lenticular $50 copay $125 allowance after $50 copay
Frames (every 24 months) $130 allowance (plus 20% discount on $70 allowance
remaining balance)
Contact Lens $130 allowance
Medical Necessary Contact Lenses (12 Months) $25 copay $210 allowance after $25 copay
Elective Contact Lenses Exam (12 Months) Maximum of $60 copay $105 allowance for professional fees
and materials
Diabetic Eye Care Program
Ophthalmological Service & Office Visit (12 Months) $20 copay
Gonioscopy (12 months) 100%
Extended Ophthalmoscopy (6 months) 100% n/a
Fundus Photography (6 months) 100%
Lasik Vision Correction Average 15% off the regular price or 5% off the promotional price�
Discounts only available from contracted facilities
2019 Employee Vision Contributions
Monthly
Employee $2 DID YOU
Employee + 1 $4 KNOW?!
Family $6
The frequencies listed for each service
are based upon the last date of service
received and do not reset at the beginning
of the plan year. Please contact VSP
customer service at 1-800-877-7195 if
you have any questions regarding your
last date of service.
11
Vision Plan
VSP
Heico offers a vision plan through Vision Service Plan (VSP) utilizing their Signature Plan Network� Please visit www.vsp.com for a
complete listing of participating providers in-network�
VSP Plan Design In-Network Out-of-Network
Eye Exam (every 12 months) $25 copay $50 allowance after $25 copay
Lenses (every 12 months)
Single Lens $50 copay $50 allowance after $50 copay
Lined Bifocal Lens $50 copay $75 allowance after $50 copay
Lined Trifocal Lens $50 copay $100 allowance after $50 copay
Lenticular $50 copay $125 allowance after $50 copay
Frames (every 24 months) $130 allowance (plus 20% discount on $70 allowance
remaining balance)
Contact Lens $130 allowance
Medical Necessary Contact Lenses (12 Months) $25 copay $210 allowance after $25 copay
Elective Contact Lenses Exam (12 Months) Maximum of $60 copay $105 allowance for professional fees
and materials
Diabetic Eye Care Program
Ophthalmological Service & Office Visit (12 Months) $20 copay
Gonioscopy (12 months) 100%
Extended Ophthalmoscopy (6 months) 100% n/a
Fundus Photography (6 months) 100%
Lasik Vision Correction Average 15% off the regular price or 5% off the promotional price�
Discounts only available from contracted facilities
2019 Employee Vision Contributions
Monthly
Employee $2 DID YOU
Employee + 1 $4 KNOW?!
Family $6
The frequencies listed for each service
are based upon the last date of service
received and do not reset at the beginning
of the plan year. Please contact VSP
customer service at 1-800-877-7195 if
you have any questions regarding your
last date of service.
11
