Page 14 - PriMed 2022 Benefits Guide

Vision Coverage – New Plan Choice for 2022

Vision Plan Highlights
Vision benefits are offered through Vision Service Plan (VSP). Each time you need services, you can decide
whether to use a VSP network provider or an out of network provider. However, you pay less when you visit
VSP network providers.
If You Visit a VSP Network Provider
If you visit a VSP network provider, then you receive a higher coverage level than if you visit an out-of-network
provider. In general, you pay a copay, the plan pays 100% up to the plan allowances. You do not need to file a
claim form.
If You Visit an Out-Of-Network Provider
If you choose to visit an out-of-network provider, then you pay the provider in full (including copays) at the
time of service and submit a claim for reimbursement to VSP. The plan will then reimburse you up to the
allowable expense for each covered service. The claim form is available on the VSP Website:
http://www.vsp.com.

VSP Vision Base Plan In-Network
$20 – well vision exam
Copay $30 – prescription glasses
Up to $60 – contacts
Exam every 12 months* 100% up to plan allowance
Frames every 24 months* $150 allowance
Lenses every 24 months*
Single, Bifocal, Trifocal 100% up to plan allowance
Lens Enhancements
Standard Progressive Lenses Covered in full
Premium Progressive Lenses $95 - $105 copay
Custom Progressive Lenses $150 - $175 copay
Contact Lenses (in lieu of lenses and frames) every 24 months $150 allowance

VSP Vision Enhanced Plan In-Network
$10 – well vision exam
Copay $30 – prescription glasses
Up to $60 – contacts
Exam every 12 months* 100% up to plan allowance
Frames every 12 months* $150 allowance
Lenses every 12 months*
Single, Bifocal, Trifocal 100% up to plan allowance
Lens Enhancements
Standard Progressive Lenses Covered in full
Premium Progressive Lenses $95 - $105 copay
Custom Progressive Lenses $150 - $175 copay
Contact Lenses (in lieu of lenses and frames) every 12 months $150 allowance
Easy Options**
Choice of: $100 Additional Frame Allowance /OR/ $100 Additional Contact Lens Allowance /OR/ Anti-
Reflective Lenses /OR/ Progressive Lenses /OR/ Photochromic Lenses, every 12 months
*Calendar Year Service Dates
**VSP Easy Options allows members to customize their benefit in the doctor’s office after they have received their exam. Each employee and their
dependents have the choice to select a different covered upgrade that meets their personal needs

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