What benefits does the plan offer? Vision Insurance Schedule Benefit Frequency
In-Network Member Cost Out-of-Network Benefit
Vision Exam - focuses on your eye health and overall wellness
Every 12 months
$10 copay
Up to $52
Average 15% off the regular price or 5% off the promotional price. Available from contracted facilities.
Laser Vision Correction Discount Once per eye per lifetime
N/A
Lenses
Single Lined Bifocal Lined Trifocal Lenticular
Up to $55 Up to $75 Up to $95 Up to $125
$25 copay (lenses and frame)
Every 12 months
$130 allowance for the frame of your choice and 20% off the amount over your allowance. $130 allowance for a contact lens exam (fitting and evaluation) and materials. If you choose contact lenses you will be eligible for frames 12 months from the date the contact lenses were obtained.
Frames
Every 24 months
$57
Elective Contact Lenses
Every 12 months
Up to $105
Contact lenses are in place of lenses and frame.
Visually Necessary Contact Lenses
Visually necessary contact lenses are covered in full when specific benefit criteria are satisfied and when prescribed by a network provider. $25 copay. 30% off additional glasses and sunglasses, including lens options, from the same VSP doctor on the same day as your exam. Or get 20% off from any VSP doctor within 12 months of your last exam.
Up to $210
Available one time each benefit period.
Additional Glasses and Sunglasses Discount
N/A
45
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