Benefits |
|
|
| 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.
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