Page 18 - 2016 Open Enrollment

Open
Enrollment

Vision Plan
The vision plan administered by VSP provides afordable eye care with
Vision Plan Summary discounts on rouine eye exams, frames, prescripion glasses, and/

or contact lenses. For more details see the vision plan summary plan
descripion posted on www.DANbeneitsPLUS.com.

Vision Service Plan
In-Network Out-of-Network
2016 Employee Contribuions Per Pay Period
Employee $3.54
Employee + Spouse $7.08
Employee + Child(ren) $7.57
Family $12.10
Plan Feature*
Well Vision Exam $10 copay Up to $45
(every calendar year)
Lenses/Prescripion Glasses $25 copay Single: up to $30
(every calendar year) Bifocal: up to $50
Trifocal: up to $65
Lenicular: up to $100
Frames (every 12 months) $160 allowance + 20% of Up to $70
amount over allowance
Elecive Contact Lens Care $160 allowance for Up to $105
(every 12 months) contacts; iing and
evaluaion up to $60 copay
Medically Necessary Covered in full Up to $210
Contact Lens Care (every 12
months)
Laser Vision Correcion Average 15% of regular Not covered
(contracted faciliies only) price or 5% of promoional
price

Find an In-Network
VSP provider at
www.vsp.com or call
1-800-877-7195.

18