Benefits for the vision plan are listed below. For maximum benefits, services must be received by a VSP physician. This optional plan does not replace medical coverage for eye disease or injury covered under the medical plan.

Frequencies from last date of service:

• Examination - once every 12 months (365 days)
• Contact Lenses - once every 12 months in lieu of a complete pair of eyeglasses.
• Lenses - once every 12 months
• Frames - once every 24 months

	Network	Non-Network
Benefits
Examinations	$20 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 amount over the frame allowance.)	reimbursed up to $45
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)	$20 copayment for exam, reimbursed up to $1250 allowance + 15% discount off the cost of the contact lens exam (fitting and evaluation)	Reimbursed up to $36 for exam, reimbursed up to $105 allowance
Necessary (If medically necessary with prior approval)	$20 copayment for exam. Additional costs covered at 100%.	Reimbursed up to $36 for exam, reimbursed up to $210 allowance
Laser Procedures: VSP also offers coverage for different types of corrective laser surgeries with approved laser surgeons and centers. The maximum amount you pay is $1,500 per eye for PRK or $1,800 per eye for LASIK. You may call VSP for additional information on these procedures.