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BENEFITS

Vision Insurance

Guardian | Voluntary PPO Vision Plan
The Guardian vision plan provides professional vision care and high-quality lenses and frames through a broad network of optical
specialists. You will receive richer benefits if you utilize a network provider. If you use a non‐network provider, you will be
responsible for paying all charges at the time of your appointment and will be required to file an itemized claim with Guardian.

Guardian Note
Plan Name PPO Guardian’s Vision
plan utilizes the VSP
Network Name VSP Choice Non-Network network, which has
Vision Benefits the most extensive
network of private-
Copay practice eye care
- Examination $10 Copay N/A doctors in the
- Materials $25 Copay N/A industry. Most of
the US population
Examination (Every 12 Months) No Charge $39 Reimbursement
lives within four
Lenses (Every 12 Months) miles of a VSP
- Single Vision No Charge $23 Reimbursement provider. VSP also
- Lined Bifocal No Charge $37 Reimbursement contracts with
- Lined Trifocal No Charge $49 Reimbursement Costco Optical,
- Lenticular No Charge $64 Reimbursement Visionworks,
Clarkson Eyecare,
Frames (Every 12 Months) $130 Allowance, $46 Reimbursement
Shopko Eyecare
then 20% Discount
Costco: $70 Allowance Center, Visioncare
Associates,
Contact Lenses (Every 12 Months) In Lieu of Frames and Lenses Rxoptical, and other
affiliate retail
- Cosmetic / Elective $130 Allowance $100 Reimbursement
providers. Please
- Medically Necessary No Charge $210 Reimbursement
note, benefits may
Cosmetic Extras Average 20-25% Discount Not Covered vary at affiliate
to Retail Cost locations.
Additional Pair of Frames/Lenses 20% Discount to Retail Cost Not Covered
Laser Vision Correction Up to 15% off the Usual Not Covered
Charge, or 5% off a
Promotional Price

Finding a Vision Provider
Call (800) 600-1600 or go to www.guardiananytime.com, Click “Find A Provider”, then Click “Search
Providers”. Under Vision Providers select VSP. Refer to the VSP Choice network when prompted.

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