YOUR VSP VISION BENEFITS SUMMARY UNIVERSITY OF CINCINNATI and VSP provide you with an affordable vision plan.
PROVIDER NETWORK: VSP Choice EFFECTIVE DATE: 01/01/2022
DESCRIPTION
COPAY
FREQUENCY
BENEFIT
COVERAGE WITH A VSP PROVIDER
• Retinal screening for members with diabetes • Additional exams and services for members with diabetes, glaucoma, or age-related macular degeneration. • Treatment and diagnoses of eye conditions, including pink eye, vision loss, and cataracts available for all members. • Limitations and coordination with your medical coverage may apply. Ask your VSP doctor for details.
$0 per screening $20 per exam
ESSENTIAL MEDICAL EYE CARE
Available as needed
See frame and lenses
PRESCRIPTION GLASSES
$25
• $200 featured frame brand allowance • $150 frame allowance
Included in Prescription Glasses Included in Prescription Glasses $17 – $33 $41 – $85 $0 $95 – $105 $150 – $175
Every other calendar year
FRAME
• 20% savings on the amount over your allowance • $80 Walmart®/Sam’s Club®/Costco® frame allowance
• Single vision, lined bifocal, and lined trifocal lenses • Impact-resistant lenses for dependent children
LENSES
Every calendar year
• Scratch-resistant coating • Anti-glare coating
LENS ENHANCEMENTS
• Standard progressive lenses • Premium progressive lenses • Custom progressive lenses • Average savings of 30% on other lens enhancements
Every calendar year
CONTACTS (INSTEAD OF GLASSES)
• $130 allowance for contacts; copay does not apply • Contact lens exam (fitting and evaluation)
Up to $60 Every calendar year
• $150 allowance for ready-made non-prescription sunglasses, or ready-made non-prescription blue light filtering glasses, instead of prescription glasses or contacts
Every other calendar year
$25
LIGHTCARE TM
Glasses and Sunglasses • Additional $50 to spend on featured frame brands. Go to vsp.com/framebrands for details. • 20% savings on additional glasses and sunglasses, including lens enhancements, from any VSP provider within 12 months of your last WellVision Exam. Routine 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 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
Progressives................................up to $50 Contacts......................................up to $105
Coverage with a retail chain may be different or not apply. Log in to vsp.com to check your benefits for eligibility and to confirm in-network locations based on your plan type. 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. In the state of Washington, VSP Vision Care, Inc., is the legal name of the corporation through which VSP does business.
Log in to vsp.com to find an in-network provider based on your plan type.
*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.
©2021 Vision Service Plan. All rights reserved. VSP, WellVision Exam, and LightCare are registered trademarks of Vision Service Plan. Flexon is a registered trademark of Marchon Eyewear, Inc. All other brands or marks are the property of their respective owners.
Classification: Restricted
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