Vision Insurance
Who is Eligible and When: Employees that work 35 hours per week or more are eligible for Vision lnsurance. Coverage begins after 30 days of continuous employment. Covered Charges Benefit Frequency Exams $10 copay One exam every 12 months Prescription Glasses $25 copay
Two lenses (one pair) every 12 months
Lenses
Single vision, lined bifocal, lined trifocal and lenticular lenses; polycarbonate lenses for dependent children under age 18 $150 allowance for a wide selection of frames; 20% off amount over allowance*** Up to $60 copay for your elective contact lens exam (fitting and evaluation)
Members pay for lens enhancements as an out-of- pocket expense after the copay; they are discounted 20-25% by VSP providers.***
One set every 12 months
Frames*
Once every 12 months
Elective Contacts
$150 allowance for elective contacts
Contacts are instead of frames and lenses
$25 copay
Once every 12 months
Necessary Contacts**
Covered in full for members who have specific conditions
Contacts are instead of frames and lenses
Additional Savings ***
Glasses and Sunglasses Members save an average of 20-25% off additional glasses and sunglasses, including lens options, from any VSP doctor within 12 months of your last covered vision exam Laser Vision Correction Average 15% off the regular price or 5% off the promotional price; discounts only available from contracted facilities Your Coverage with Other Providers (Non-Network) Covered Charges Scheduled Benefit Amount Frequency Vision Exams Up to $45 One per 12 month period Single Vision lenses Up to $30 One pair per 12 month period Lined bifocal lenses Up to $50 One pair per 12 month period Lined trifocal lenses Up to $65 One pair per 12 month period Lenticular lenses Up to $100 One pair per 12 month period Frames Up to $70 One set per 12 month period Elective Contacts Up to $105 In lieu of lenses and frame benefits Necessary Contacts** Up to $210 In lieu of lenses and frame benefits Vision Plan Employee Bi-Weekly Contribution Employee
$3.15 $6.97 $7.46 $12.14
Employee + Spouse Employee + Family Employee + Child(ren)
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