Vision Plan
through Vision Service Plan (VSP)
www.vsp.com

This plan does not replace medical coverage for eye disease or injury. Contact your medical plan for these services.

The vision plan offers specific copayments for services at VSP doctors and gives allowances when you obtain services from non-network doctors. To access services, call a VSP doctor to make an appointment. The doctor will need the subscriber’s full name and last four digits of the Social Security number to verify eligibility. Contact VSP for a provider directory. VSP does not issue identification cards.

When services are received from a VSP doctor, reimbursement is made directly to the physician. You only owe your copayments unless optional items are selected that the plan does not cover. Optional items include, but are not limited to:

• Frames that exceed the plan's allowance.
• Oversized lenses.
• Tints.
• Coatings.
• No-line multifocal lenses.

Ask the VSP doctor the cost of optional items before ordering; however, VSP doctors charge the recommended fees for optional items, so your costs are controlled.

Frequencies are from last date of service:

• Examination, once every 12 months (365 days)
• Contact lenses obtained once every 12 months in lieu of eyeglass lenses
• Lenses, once every 12 months
• Frames, once every 24 months

Submit bills for services obtained from non-network providers within 12 months of the date of service to:

Vision Service Plan
P.O. Box 997105
Sacramento, CA 95899-7105.

Refer to the benefit summary for reimbursement.