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Vision - VSP

Your vision program, insured by VSP, also offers you two options for coverage, network and non-network care.
This plan provides each covered family member with coverage for eye exams and necessary corrective lenses,
including eyeglasses or contact lenses.

VSP has a large network of member providers. If you choose to use one of those providers, you will pay
substantially less than if you go to a provider outside the VSP network. To locate an VSP participating provider
in your community, call 1-800-877-7195 or visit the VSP website at www.vsp.com to find a VSP Network
Provider.

Refer to the VSP materials in the appendix for information on plan benefits and processing out-of-network
claims. All out-of-network vision claims must be submitted within six months of the date of service.

Out-of-Network
Benefits and Covered Services In-Network
Reimbursement
Annual Exam $10 copay Up to $50 (copay applies)
$25 copay, $130 Retail Allowance, 20% discount on charges
Frames Up to $70 (copay applies)
over $130
Lenses
Single $25 copay Up to $50 (copay applies)
Bifocal $25 copay Up to $75 (copay applies)
Trifocal $25 copay Up to $100 (copay applies)

Contact Lenses
Elective (in lieu of glasses) $120 allowance Up to $105
Medically necessary Covered at 100% Up to $210
Exam: Once every calendar year
Frequency Lenses: Once every calendar year
Frames: Once every other calendar year
Additional charge, discounted at network providers.
Tints, Special Coatings, etc. on
lenses Not applicable to out of network coverage.

Click here for a detailed Vision Plan Summary

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