Page 18 - Tender Greens EE Guide 01-20

VSP | Vision Plan
Tender Greens provides vision coverage through VSP. You can see a VSP Choice in-network provider or an out-of-network
provider, however, your costs will be lower if you visit an in-network provider. If you visit an in-network provider you will be
responsible for a copayment at the time of your service. If you receive services from an out-of-network doctor, you will pay all
costs at the time of service and submit a claim for reimbursement.

VSP
Plan Name PPO
Network Name VSP Choice Non-Network

Vision Benefits
Copay
- Examination $10 Copay N/A
- Materials $25 Copay N/A
Examination (Every 12 Months) No Charge Up to $45 Reimbursement
Lenses (Every 12 Months)
- Single Vision No Charge Up to $30 Reimbursement
- Bifocal No Charge Up to $50 Reimbursement
- Trifocal No Charge Up to $65 Reimbursement
Lens Enhancements
- Progressive (Standard/Premium/Custom) $0-$175 Copay Up to $50 Reimbursement
- Other Lens Enhancements 20-25% Discount Not Covered
Frames (Every 24 Months) $130—$150 Benefit Up to $70 Reimbursement
($70 Walmart / Costco)
Contact Lenses (Every 12 Months) (in lieu of frames and lenses)
- Exam Up to $60 Copay N/A
- Cosmetic / Elective $130 Benefit Up to $105 Reimbursement

Finding a Vision Provider
Go to www.vsp.com. Refer to the “Choice” network

VSP has the largest network of private-practice eye care doctors in the industry.
VSP’s network includes 50,000 access points nationwide. VSP also contracts with
Costco Optical, Visionworks, and other affiliate retail providers. Please note,
benefits may vary at affiliate locations.

Additional Discounts Available
• Glasses and Sunglasses: Get an extra $20 to spend on featured frame brands. Go to www.vsp.com/
offers for details. You may also receive 20% savings on additional glasses and sunglasses, including lens
enhancements, from any VSP provider within 12 months of your last wellness exam.
• Retinal Screening: Spend no more than a $39 copay on a routine retinal screening as an enhancement
to your vision exam.
• Laser Vision Correction: Receive an average 15% discount to the regular price, or 5% off the promotional
price. Discounts are only available at contracted facilities.

18 Team Member Benefits