Vision through Vision Service Plan (VSP)
| Benefits | Network | Non-Network ** |
|---|---|---|
| Examinations | $10 copayment | Reimbursed up to $36 |
| Materials * | ||
| Single vision lenses (per pair) | $25 copayment | Reimbursed up to $28 |
| Bifocal lenses (per pair) | $25 copayment | Reimbursed up to $45 |
| Trifocal lenses (per pair) | $25 copayment | Reimbursed up to $56 |
| Lenticular lenses (per pair) | $25 copayment | Reimbursed up to $80 |
| Frames - once every 24 months* | $25 copayment ($120 retail allowance + 20% discount on any out-of-pocket costs) | Reimbursed up to $45 |
| Polycarbonate lenses for dependent children are covered at a VSP doctor at no additional cost. | Not covered | |
| Optional items (cosmetic extras) | Not covered | Not covered |
| Contact Lenses and Associated Services Including Evaluation, Design and Fitting | ||
| Elective (If member prefers contacts to glasses) |
$10 copayment for exam. Up to $125 allowance for cost of contacts and contact lens exam (fitting
and evaluation). This exam is in addition to your vision exam to ensure proper fit of contacts. 15% discount on the cost of contact lens exam (fitting and evaluation) |
Reimbursed up to $36 for exam Contact lenses and fitting and evaluation exam reimbursed up to $105 allowance |
| Necessary *** (If medically necessary with prior approval) |
$10 copayment for exam Additional costs covered at 100%. |
Reimbursed up to $36 for exam Contact lenses and fitting and evaluation exam reimbursed up to $210 allowance |
* One $25 copayment for lens and frame.
** All applicable copayments apply.
*** Requires prior approval from VSP.
Receive 20% off additional prescription and non-prescription glasses and sunglasses. Current soft contact lens wearers may qualify for a special contact lens program that includes a contact lens evaluation and initial supply of replacement lenses. Learn more from VSP.