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Benefits For Your Health

VISION INSURANCE

VSP | PPO Vision Plan

The VSP 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 utilize a non-network provider, you will be
responsible to pay all charges at the time of your appointment and will be required to file an itemized claim with VSP.

Plan Name VSP—Choice

Network Network Non-Network
Vision Benefits

Deductible
- Examination $10 N/A
- Materials $0 N/A
Examination $10 Up to $45 Reimbursement

Lenses
- Single Vision Covered 100% Up to $30 Reimbursement
- Lined Bifocal Covered 100% Up to $50 Reimbursement
- Lined Trifocal Covered 100% Up to $65 Reimbursement
- Polycarbonate Covered 100% Not Covered
- Standard Progressive $55 Up to $50 Reimbursement
- Premium Progressive $95-$105 Up to $50 Reimbursement
- Custom Progressive $150-$175 Up to $50 Reimbursement
- Other Lens enhancements 20-25% Average Savings Not Covered
Frames $175 Allowance, 20% Up to $70 Reimbursement
Savings Over Allowance
Contact Lenses (In Lieu of Frames and Lenses)
- Cosmetic / Elective $175 Allowance Up to $105 Reimbursement
- Medically Necessary 100% Up to $210 Reimbursement

Laser Vision Correction Average 15% Discount Off Regular Price Not Covered
or 5% Discount Off Promotional Price
Frequency
- Examination Every 12 Months
- Lenses Every 12 Months
- Frames Every 24 Months
- Contact Lenses Every 12 Months

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, Eye Care Centers of America / Visionworks, and other affiliate retail providers.
Please note, benefits may vary at affiliate locations.

Finding a Vision Provider
Go to www.vsp.com or call (800) 877-7195. Refer to the Choice network when prompted.

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