Page 9 - 2018 USI Enrollment
P. 9
University of Southern Indiana
Vision VSP Provider Search
You can elect vision insurance with Vision Service Plan (VSP) for you and X Visit www.vsp.com
your family members. Visit www.vsp.com to ind in-network providers X Click on Find a Doctor
and access to a variety of online tools and programs. VSP has one of the X Search by ZIP Code or address
largest networks of independent providers and includes major retailers
such as Heartland Vision, Rx Optical, SVS Vision, CostCo Optical, Tavel,
and Visionworks.
In-Network Out-of-Network
Vision Exam $10 copay Up to $45
Lenses and Frames
Single-Vision $10 copay Up to $30
Bifocal $10 copay Up to $50
Trifocal $10 copay Up to $65
Lenticular $10 copay Up to $100
Frames $10 copay, $130 Up to $70
allowance; 20% off
balance over allowance
Contact Lenses (in lieu of glasses)
Elective $150 allowance Up to $105
Elective Contact Lens Fitting and Covered in full, after a The elective contact
Evaluation maximum $60 copay lens allowance
applies to both the
itting, evaluation,
and the materials
Medically Necessary $0 copay, covered in full Up to $210
Beneit Frequency
Exam 12 months
Lenses 12 months
Frames 24 months
Contacts 12 months
Employee Contributions
Bi–Weekly Monthly
Employee Only $4.04 $8.08
Employee and Spouse $7.07 $14.14
Employee and Child(ren) $7.68 $15.36
Employee and Family $11.74 $23.48
9
Vision VSP Provider Search
You can elect vision insurance with Vision Service Plan (VSP) for you and X Visit www.vsp.com
your family members. Visit www.vsp.com to ind in-network providers X Click on Find a Doctor
and access to a variety of online tools and programs. VSP has one of the X Search by ZIP Code or address
largest networks of independent providers and includes major retailers
such as Heartland Vision, Rx Optical, SVS Vision, CostCo Optical, Tavel,
and Visionworks.
In-Network Out-of-Network
Vision Exam $10 copay Up to $45
Lenses and Frames
Single-Vision $10 copay Up to $30
Bifocal $10 copay Up to $50
Trifocal $10 copay Up to $65
Lenticular $10 copay Up to $100
Frames $10 copay, $130 Up to $70
allowance; 20% off
balance over allowance
Contact Lenses (in lieu of glasses)
Elective $150 allowance Up to $105
Elective Contact Lens Fitting and Covered in full, after a The elective contact
Evaluation maximum $60 copay lens allowance
applies to both the
itting, evaluation,
and the materials
Medically Necessary $0 copay, covered in full Up to $210
Beneit Frequency
Exam 12 months
Lenses 12 months
Frames 24 months
Contacts 12 months
Employee Contributions
Bi–Weekly Monthly
Employee Only $4.04 $8.08
Employee and Spouse $7.07 $14.14
Employee and Child(ren) $7.68 $15.36
Employee and Family $11.74 $23.48
9
