YOUR VSP VISION BENEFITS SUMMARY University of Cincinnati and VSP provide you with a choice of affordable vision plans. Choose the eye care essentials to give your eyes extra love.
PROVIDER NETWORK: Choice EFFECTIVE DATE: āĥāĥ 20 ĂĀ
Description
Copay
Frequency
Benefit
Coverage with a VSP Provider
PRESCRIPTION GLASSES
$25
• $1 Ć 0 allowance for a wide selection of frames • $1 Ĉ 0 allowance for featured frame brands • 20% savings on the amount over your allowance • $ ĉ 0 Costco/Walmart/Sam’s Club frame allowance
Included in Prescription Glasses
Every other calendar year
Frame
Included in Prescription Glasses
• Single vision, lined bifocal, and lined trifocal lenses • Impact-resistant lenses for dependent children
Every calendar year
Lenses
• Scratch-resistant coating • Anti-reflective coating
$17 – $33 $41 – $85 $0 $95 – $105 $150 – $175
Every calendar year
Lens Enhancements
• Standard progressive lenses • Premium progressive lenses • Custom progressive lenses • Average savings of 20–25% on other lens enhancements
Contacts (instead of glasses)
Every calendar year
• $1 ă 0 allowance for contacts; copay does not apply • Contact lens exam (fitting and evaluation)
Up to $60
• Services related to diabetic eye disease, glaucoma, and age-related macular degeneration (AMD). Retinal screening for eligible members with diabetes. Limitations and coordination with medical coverage may apply. Ask your VSP doctor for details.
VSP DIABETIC EYECARE PLUS PROGRAM SM
$20
As needed
Glasses and Sunglasses • Extra $20 to spend on featured frame brands. Go to vsp.com/specialoffers for details. • 20% savings on additional glasses and sunglasses, including lens enhancements, from any VSP provider within 12 months of your last WellVision Exam. Retinal Screening • No more than a $39 copay on routine retinal screening as an enhancement to a WellVision Exam. Laser Vision Correction • Average 15% off the regular price or 5% off the promotional price; discounts only available from contracted facilities.
EXTRA SAVINGS
YOUR MONTHLY CONTRIBUTION
$3.82 $7.64
$8.18 $13.08
• Employee Only • Employee + ,+1/!ĥ+)!/0% ƫ .0*!.
• Employee + Child(ren) • Employee + Family
YOUR COVERAGE WITH OUT-OF-NETWORK PROVIDERS Get the most out of your benefits and greater savings with a VSP network doctor. Call Member Services for out-of-network plan details.
Frame ............................... up to $70 Single Vision Lenses ...up to $30
Lined Bifocal Lenses...up to $50 Lined Trifocal Lenses.. up to $65
Lined Trifocal Lenses.. up to $65 Progressive Lenses......up to $50
Contacts ........................ up to $105
Coverage with a retail chain may be different or not apply. VSP EasyOptions Plan Benefits are not available at Walmart or Costco. VSP guarantees coverage from VSP providers only. Coverage information is subject to change. In the event of a conflict between this information and your organization’s contract with VSP, the terms of the contract will prevail. Based on applicable laws, benefits may vary by location.
*Only available to VSP members with applicable plan benefits. Frame brands and promotions are subject to change. Savings based on doctor’s retail price and vary by plan and purchase selection; average savings determined after benefits are applied. Ask your VSP network doctor for more details. ©2019 Vision Service Plan. All rights reserved. VSP, VSP Vision Care for life, Eyeconic, and WellVision Exam are registered trademarks, and VSP Diabetic Eyecare Plus Program is a service mark of Vision Service Plan. All other brands or marks are the property of their respective owners. 55324 VCCM
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