Page 13 - 2018 Endeavor Schools Benefit Guide

11

Keep An Eye On Your

Vision Coverage

Wellness is also about keeping your eyes healthy. When you visit your eye doctor,
they are not just looking for vision problems. Your eyes are an indicator of your
overall health, and eye exams can reveal early warning signs of eye disease, as
well as serious health problems such as high blood pressure, high cholesterol,
and diabetes. Regardless of your age, it is recommended that you have your eye
exam once a year.

What’s in it for you?
Options. It’s simple really. Vision Service Plan (VSP) is dedicated to helping you
see clearly — and that’s why they have built a network that gives you lots of choices and flexibility. You can choose from
thousands of independent and retail providers to find the one that best fits your needs and schedule. No matter which
one you choose, the plans from Vision Service Plan (VSP) are designed to be easy-to-use and help you access the care
you need.
For a complete list of in-network providers near you, go to www.vsp.com or call 1-800-877-7197. When searching for
providers choose the VSP Choice network.

Vision Plan Highlights

Summary of Services In-Network Out-of-Network

Eye Exams (Well Vision Exams) You will be reimbursed:
(once every 12 months) $10 copay Up to $45

Lenses You will be reimbursed:
(once every 12 months)
• Single Vision $25 copay then 100% Up to $30
• Bifocal $25 copay then 100% Up to $50
• Trifocal $25 copay then 100% Up to $65

Frames 1 $130 retail frame allowance You will be reimbursed:
(once every 24 months) Up to $70

Contact Lenses—Elective 2 You will be reimbursed:
(once every 12 months) Up to $130 allowance 3 Up to $105

Contact Lenses You will be reimbursed:
Medically Necessary $25 copay then 100% Up to $210

Benefit Disclosure—The above chart is for illustrative purpose only; actual benefits described in SPD will prevail.
¹The insured is responsible for paying any charges in excess of this allowance.
2 Contact Lenses are in lieu of frames/lenses.
³Your $130 allowance is applied to the fitting/evaluation fees as well as the purchase of contact lenses.
4 The Necessary contact lenses are determined at the provider’s discretion for one or more of the following conditions: Following cataract surgery; To
correct extreme vision problems that cannot be corrected with spectacle lenses; With certain conditions of anisometropia; With certain conditions of
keratoconus. If your provider considers your contacts necessary, you should ask your provider to contact VSP concerning the reimbursement that VSP
will make before you purchase such contacts.