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BENEFITS

VISION INSURANCE

VSP | VISION PLAN
The VSP vision plan provides professional vision care and high quality lenses and frames through a broad network of op cal
specialists. You will receive richer benefits if you u lize a network provider. If you u lize a non‐network provider, you will be
responsible to pay all charges at the me of your appointment and will be required to file an itemized claim with VSP.

All Areas
VSP
PLAN NAME SIGNATURE PLAN

Network Name Network Non‐Network
Vision Benefits
Copay
‐ Examina on $20 Copay
‐ Materials $20 Copay
Examina on (Every 12 Months) Covered in full a er copay Up to $50 Reimbursement
Lenses (Every 12 Months)
‐ Single Vision Covered in full a er copay Up to $50 Reimbursement
‐ Bifocal Covered in full a er copay Up to $75 Reimbursement
‐ Trifocal Covered in full a er copay Up to $100 Reimbursement
Lens Enhancements
‐ Progressive Lenses No Charge Up to $75 Reimbursement
‐ An ‐Reflec ng Coa ng No Charge Not Covered
‐ Scratch‐Resistance Coa ng No Charge Not Covered
‐ Discount Off Other Op ons 35‐40% average savings N/A
Frames (Every 24 Months) $130 Retail Allowance a er copay Up to $70 Reimbursement

Contact Lenses (Every 12 Months) Instead of Glasses
‐ Elec ve Contact Lens Exam 15% discount, $60 max copay Not Covered
‐ Elec ve Contacts $130 Allowance Up to $105 Reimbursement
Computer Vision Care*

Copay $25 Copay Not Covered
Examina on (Every 12 Months) 100% Not Covered
Lenses (Every 12 Months)
‐ Single Vision 100% Not Covered
‐ Bifocal 100% Not Covered
‐ Trifocal 100% Not Covered
Frames (Every 24 Months) $90 Allowance Not Covered
*Computer Vision Care coverage is available to enrolled employees only.

LOCATING A VISION PROVIDER

Go to www.vsp.com or download the VSP mobile app, available on iTunes or the Google Play Store
Refer to the “VSP Signature” network when prompted

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