Page 12 - 2017 Benefits Enrollment
P. 12
Annual
Enrollment
Vision Plan Vision Plan
The vision plan administered by VSP provides afordable eye care with
Summary discounts on rouine eye exams, frames, prescripion glasses, and/or contact
lenses. For more details see the vision plan summary plan descripion posted
Find an In-Network VSP on www.DANbeneitsPLUS.com.
provider at www.vsp.com or
call 1-800-877-7195. Vision Service Plan
In-Network Out-of-Network
2017 Employee Contribuions Per Pay Period
Employee $3.50
Employee + Spouse $7.00
Employee + Child(ren) $7.49
Family $11.96
Plan Feature
Well Vision Exam $10 copay Up to $45
(every calendar year)
Single: up to $30
Lenses/Prescripion Glasses $25 copay Bifocal: up to $50
(every calendar year) 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 contacts; Up to $105
iing and evaluaion up to
(every 12 months) $60 copay
Medically Necessary Contact $25 Copay Up to $210
Lens Care (every 12 months)
Laser Vision Correcion Average 15% of regular
(contracted faciliies only) price or 5% of promoional Not covered
price
Lens Enhancements
f
NEW! Scratch Resistant $0 Copay N/A
Coaings
f Ani-Relecive Coaings $25 Copay N/A
Addiional services using your VSP coverage can be found online at
www.eyeconic.com! This site can show you the latest deals and promoions
on eyewear and contact lenses—keeping you in the loop on all the newest
brands, trends. and styles available. There is even a virtual ‘dressing room’ to
try on your eyewear before you orderl
No mater what kind of eye products you use now, or you might try in the
future, we have you covered. Eyeconic even makes it easy to apply insurance
toward an online purchase, and includes the opion to uilize the experise of
our VSP doctor network.
©
12
Enrollment
Vision Plan Vision Plan
The vision plan administered by VSP provides afordable eye care with
Summary discounts on rouine eye exams, frames, prescripion glasses, and/or contact
lenses. For more details see the vision plan summary plan descripion posted
Find an In-Network VSP on www.DANbeneitsPLUS.com.
provider at www.vsp.com or
call 1-800-877-7195. Vision Service Plan
In-Network Out-of-Network
2017 Employee Contribuions Per Pay Period
Employee $3.50
Employee + Spouse $7.00
Employee + Child(ren) $7.49
Family $11.96
Plan Feature
Well Vision Exam $10 copay Up to $45
(every calendar year)
Single: up to $30
Lenses/Prescripion Glasses $25 copay Bifocal: up to $50
(every calendar year) 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 contacts; Up to $105
iing and evaluaion up to
(every 12 months) $60 copay
Medically Necessary Contact $25 Copay Up to $210
Lens Care (every 12 months)
Laser Vision Correcion Average 15% of regular
(contracted faciliies only) price or 5% of promoional Not covered
price
Lens Enhancements
f
NEW! Scratch Resistant $0 Copay N/A
Coaings
f Ani-Relecive Coaings $25 Copay N/A
Addiional services using your VSP coverage can be found online at
www.eyeconic.com! This site can show you the latest deals and promoions
on eyewear and contact lenses—keeping you in the loop on all the newest
brands, trends. and styles available. There is even a virtual ‘dressing room’ to
try on your eyewear before you orderl
No mater what kind of eye products you use now, or you might try in the
future, we have you covered. Eyeconic even makes it easy to apply insurance
toward an online purchase, and includes the opion to uilize the experise of
our VSP doctor network.
©
12
