Page 13 - 2022 Clari Open Enrollment Benefits Guide
P. 13

Vision







        VSP Vision Plan (Group #30100697)

        Clari offers vision coverage with the Vision Service Plan (VSP). When using an in-network provider, simply tell them at your appointment
        you have VSP and provide your name, date of birth and social security number to verify benefits and coverage. Covered family members also
        use your personal information to confirm benefits. VSP will not mail ID cards, though you can print a vision card when you log in to vsp.com.



                                                                       VSP VISION PLAN

                 BENEFIT                             WHAT’S INCLUDED / HOW OFTEN                                    COPAYS OR ALLOWANCES
         Well Vision Exam        Once every calendar year                                               $10 copay
                                 Routine retinal screening as an enhancement to a Well Vision Exam      No more than $39 copay
         Prescription Glasses

         •  Lenses               •  Lenses covered once every calendar year                             $25 copay for lenses
                                   Includes single vision, lined bifocal, lined trifocal, standard progressives  Additional costs for other lens enhancements

         •  Frames               •  Frames covered once every calendar year                             $150 frame allowance
         Contact Lenses          Purchase in lieu of glasses every calendar year                        $150 contact lens allowance
                                                                                                        No more than $60 for fitting/evaluation
         Laser Vision Correction  Average up to 15% off regular price from VSP contracted facilities    Discount only

         Services Received       Expenses from non-network providers must be paid in full and submitted for reimbursement through VSP.
         Out-of-Network          Reimbursement maximums will apply (e.g. $45 frames, $30 single vision lenses).

        Commonly used benefit attributes are listed above; additional benefit information is available in your plan summary.





                       Quick Tip

                       For maximum convenience you have access to VSP retail network providers such as Visionworks. Costco Optical is a network
                       provider for materials (glasses and contacts). Eye doctors may not be in-network. Verify with VSP before scheduling your exam at

                       Costco Optical. Discounts are available on contact lens supplies, Lasik surgery, and other services. Visit vsp.com for details.



     11    We've Got You Covered     Your Health     Your Tax-Savings Accounts     Your Safety Net     Your Family     Your Well-being     Your "Me" Time     Your Contacts
   8   9   10   11   12   13   14   15   16   17   18