Page 15 - 2015 OE Sample Guidebook
P. 15
VISION CARE COVERAGE
The VSP provider services include:
Standard Discount Plan
Eye exams through a choice of eye care doctors in one of the If you enroll in a medical plan, you
nation’s largest networks will automatically receive discounts
A wide selection of eyeglasses and contact lenses with savings on on vision services such as eye exams,
eyewear and lenses prescription lenses, frames, and contact
lenses through a participating Davis
Additional coverage for popular lens options, vision therapy and Vision network provider.
additional pairs of eyeglasses
30% off unlimited additional pairs of prescription glasses and VSP Optional Vision
Plan
prescription sunglasses when purchased on the same day of the
exam from the VSP provider that gave the eye exam You have the option to purchase
optional vision care beneits through
New and current contact lens wearers are eligible for a contact lens VSP. See page 22 for Optional Vision
evaluation at no cost and an initial supply of lenses from VSP’s Care rates. VSP offers a larger network
newly expanded list, including toric, multifocal, and hydrogel of vision care providers and discounts
on eyewear. To ind a VSP provider near
Increased allowances out-of-network you, go to www.vsp.com. If you enroll,
Type II diabetics can have more than one annual exam (subject to a you are required to continue until next
enrollment. If you decline or waive
separate copay) coverage, you must wait to re-enroll
You can now print a generic ID card via the VSP website after two years.
Plan Features VSP Signature Plan
Copays $10 Exam/$25 Prescription
Glasses
Exam Covered
Lenses Covered Single Vision, Lined Bifocal, Lined
Trifocal Lenses
Covered Lens Options Polycarbonate lenses for
(if no lens options are outlined then there is dependent children
no coverage only member preferred pricing
discounts in-network)
Frame Allowance $150
Elective Contact Lenses $150
Out-of-Network Schedule
Exam $50
Single Vision $50
Bifocal $75
Trifocal $100
Frame $70
Elective Contact Lenses $105
See your Human Resources representative for additional information
and a list of discounted vision care service providers in your area.
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The VSP provider services include:
Standard Discount Plan
Eye exams through a choice of eye care doctors in one of the If you enroll in a medical plan, you
nation’s largest networks will automatically receive discounts
A wide selection of eyeglasses and contact lenses with savings on on vision services such as eye exams,
eyewear and lenses prescription lenses, frames, and contact
lenses through a participating Davis
Additional coverage for popular lens options, vision therapy and Vision network provider.
additional pairs of eyeglasses
30% off unlimited additional pairs of prescription glasses and VSP Optional Vision
Plan
prescription sunglasses when purchased on the same day of the
exam from the VSP provider that gave the eye exam You have the option to purchase
optional vision care beneits through
New and current contact lens wearers are eligible for a contact lens VSP. See page 22 for Optional Vision
evaluation at no cost and an initial supply of lenses from VSP’s Care rates. VSP offers a larger network
newly expanded list, including toric, multifocal, and hydrogel of vision care providers and discounts
on eyewear. To ind a VSP provider near
Increased allowances out-of-network you, go to www.vsp.com. If you enroll,
Type II diabetics can have more than one annual exam (subject to a you are required to continue until next
enrollment. If you decline or waive
separate copay) coverage, you must wait to re-enroll
You can now print a generic ID card via the VSP website after two years.
Plan Features VSP Signature Plan
Copays $10 Exam/$25 Prescription
Glasses
Exam Covered
Lenses Covered Single Vision, Lined Bifocal, Lined
Trifocal Lenses
Covered Lens Options Polycarbonate lenses for
(if no lens options are outlined then there is dependent children
no coverage only member preferred pricing
discounts in-network)
Frame Allowance $150
Elective Contact Lenses $150
Out-of-Network Schedule
Exam $50
Single Vision $50
Bifocal $75
Trifocal $100
Frame $70
Elective Contact Lenses $105
See your Human Resources representative for additional information
and a list of discounted vision care service providers in your area.
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