Page 13 - Sumitomo EE Guide 06-20 Final English

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 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.

All Areas
VSP
PLAN NAME SIGNATURE PLAN

Network Name Network Non-Network
Vision Benefits
Copay
- Examination $20 Copay
- Materials $20 Copay
Examination (Every 12 Months) Covered in full after copay Up to $50 Reimbursement
Lenses (Every 12 Months)
- Single Vision Covered in full after copay Up to $50 Reimbursement
- Bifocal Covered in full after copay Up to $75 Reimbursement
- Trifocal Covered in full after copay Up to $100 Reimbursement
Lens Enhancements
- Progressive Lenses No Charge Up to $75 Reimbursement
- Anti-Reflecting Coating No Charge Not Covered
- Scratch-Resistance Coating No Charge Not Covered
- Discount Off Other Options 35-40% average savings N/A
Frames (Every 24 Months) $130 Retail Allowance after copay Up to $70 Reimbursement

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

Copay $25 Copay Not Covered
Examination (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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