2023 Benefits Guide

VISION PLAN

You may locate a provider for vision in network services at www.vsp.com.

Carrier Name

Principal

Name of Plan

VSP Choice

Exam

In Network

Out of Network

Copay

$10 Copay

$45 Allowance

Frequency

12 Months

Lenses

Frequency

12 Months

Single

$25 Copay

$30 Allowance

Bifocal

$25 Copay

$50 Allowance

Trifocal

$25 Copay

$65 Allowance

Contacts Elective $150 Allowance $105 Allowance

Your eyes need a rest even while you’re awake. Use the 20 -20-20 rule to reduce eyestrain. After working for 20 minutes, look away about 20 feet in front of you for about 20 seconds.*

Contacts Medically Necessary

$25 Copay

$210 Allowance

Frames

Source: National Eye Institute https://nei.nih.gov/health/healthyeyes

Frequency

24 Months

$150 Allowance plus 20% off Balance

Frames

$70 Allowance

The benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the underlying plan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this guide, the underlying insurance documents will govern in all cases .

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