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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