Page 14 - American Business Bank EE Guide 01-19 - C2

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 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 VSP.

VSP Note
Plan Name PPO VSP has the largest
network of private-
Network VSP Choice Non-Network practice eye care
doctors in the
Vision Benefits
industry. VSP’s
Copay network includes
- Examination $10 Copay N/A 50,000 access points
- Materials $10 Copay N/A nationwide. VSP also
contracts with
Examination (Every Calendar Year) No Charge $45 Reimbursement
Costco Optical,
Lenses (Every Calendar Year) Visionworks, and
- Single Vision No Charge $30 Reimbursement other affiliate retail
- Bifocal No Charge $50 Reimbursement providers. Please
- Trifocal No Charge $65 Reimbursement note, benefits may
vary at affiliate
Frames (Every Calendar Year) $130 Allowance, $70 Reimbursement
20% Discount Off Balance locations.
Contact Lenses (Every Calendar Year) In Lieu of Frames and Lenses

- Cosmetic / Elective $130 Allowance $105 Reimbursement
- Medically Necessary No Charge $210 Reimbursement
Laser Vision Correction Discounts Apply Not Covered

Finding a Vision Provider
Go to www.vsp.com. Refer to the VSP Choice network when prompted.

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