PROVIDER NETWORK:
YOUR VSP VISION BENEFITS SUMMARY ALFRED STREET BAPTIST CHURCH and VSP provide you with an affordable vision plan.
VSP Signature
BENEFIT
DESCRIPTION
COPAY
FREQUENCY
YOUR COVERAGE WITH A VSP PROVIDER
Focuses on your eyes and overall wellness
$10
Every 12 months
WELLVISION EXAM
$10
See frame and lenses
PRESCRIPTION GLASSES
$130 allowance for a wide selection of frames $150 allowance for featured frame brands 20% savings on the amount over your allowance
Included in Prescription Glasses Included in Prescription Glasses $0 $80 - $90 $120 - $160
Every 24 months
FRAME
Single vision, lined bifocal, and lined trifocal lenses Impact-resistant lenses for dependent children
Every 12 months
LENSES
Standard progressive lenses Premium progressive lenses Custom progressive lenses Average savings of 40% on other lens enhancements
Every 12 months
LENS ENHANCEMENTS
$120 allowance for contacts; copay does not apply Contact lens exam (fitting and evaluation)
CONTACTS (INSTEAD OF GLASSES)
Up to $60
Every 12 months
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 $20 per exam
As needed
PRIMARY EYECARE SM
Glasses and Sunglasses Extra $20 to spend on featured frame brands. Go to vsp.com/offers for details.
30% savings on additional glasses and sunglasses, including lens enhancements, from the same VSP provider on the same day as your WellVision Exam. Or get 20% 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 After surgery, use your frame allowance (if eligible) for sunglasses from any VSP doctor
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. 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. EasyOptions Plan Benefits are not available at Walmart, Sam’s Club, or Costco. VSP guarantees coverage from VSP network 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.
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