Page 14 - Benefit Guide 2022

Monthly Premium
Coverage Level
VSP Low VSP High

Employee Only $1 $7

Family $3 $21
Vision Plan

The vision plan provides coverage for routine eye exams and pays for all or a portion of the cost of glasses or
contact lenses. You can choose any provider; however, you always save money if you see an in-network pro-
vider. We offer a low and high option through VSP.
Using the VSP benefit is easy. When scheduling your appointment with a network provider, identify yourself
as a VSP member through the Hillyard Companies and give the provider the employee’s birth date and social
security number. Before selecting supplies, be sure to ask about discounts. You will pay the provider for any
costs not covered through VSP. If using a non-network provider, the member will pay the provider directly
and file for reimbursement with VSP.

VSP Low Plan
The basic VSP plan covers one WellVision exam every calendar year at a participating provider. This plan also
offers a 20% discount on prescription glasses and sunglasses and a 15% discount on a contact lens exam.

VSP High Plan

VSP High VSP High
Plan Provisions In-Network Out-of-Network

Examination & Materials

Exam Copay $0 copay Up to $45
Materials Copay $25 copay $25 copay
Frequency

Examination 12 months 12 months
Lenses or Contact Lenses 12 months 12 months
Frames 24 months 24 months
$150 allowance + 20% off any balance.
Frame Allowance Feature Frame allowance=$170 Up to $70

Lenses

Single/bifocal/trifocal/lenticular Covered in full after copay Up to $30/$50/$65/$100
Standard Progressive Covered in full Up to $50

Premium Progressive $95-$175 Up to $50
Premium Anti-Reflective $41 N/A
Polycarbonate $31-$35 N/A

Contact Lenses (instead of glasses)
Elective $150 allowance Up to $105
Necessary Covered in full after copay Up to $210

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