Page 19 - Lyon Benefits Guide 01-18 National - FINAL

VISION INSURANCE

VSP | PPO
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 Vision.

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.

VSP
PPO
Network Name Choice Non-Network
VISION BENEFITS
Copay
• Examination $10 Copay N/A
• Materials $10 Copay N/A
Examination (Every 12 Months) No Charge after Copay Up to $45 Reimbursement
Lenses (Every 12 Months)
• Single Vision No Charge after Copay Up to $30 Reimbursement
• Bifocal No Charge after Copay Up to $50 Reimbursement
• Trifocal No Charge after Copay Up to $65 Reimbursement
• Polycarbonate (Children) No Charge after Copay Not Covered
• Standard Progressive $55 Copay Up to $50 Reimbursement
• Premium Progressive $95-$105 Copay
• Custom Progressive $150-$175 Copay
• Other Lens Enhancements 20% Discount Over Allowance
Frames (Every 24 Months) $130 Allowance, Up to $70 Reimbursement
$150 Featured Frame Allowance,
20% Discount Over Allowance
Contact Lenses (Every 12 Months) (in lieu of frames and lenses)
$130 Allowance Up to $105 Reimbursement
Extra Savings
• Glasses and Sunglasses Extra $20 Featured Frame Allowance at Not Covered
www.vsp.com/specialoffers,
20% Savings on Additional Glasses
• Retinal Screening $39 Copay Maximum Not Covered
• Laser Vision Correction Average 15% off Regular Price or Not Covered
5% off Promotional Price

FINDING A VISION PROVIDER
Go to www.vsp.com. Refer to the “Choice” network when prompted.

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