Vision Service Plan
Your Vision Plan through VSP offers coverage for you and your eligible dependents for eye exams, lenses, frames and contact lenses. VSP will also cover laser vision correction surgery at a discounted fee when you use a participating provider.
VSP pays for the majority of expenses for a number of services when you use a participating provider. Providers can be found on VSP’s website at www.vsp.com.
When considering whether or not to elect vision coverage, consider how often you can use these benefits:
- Exam – Once every 12 months
- Frames – Once every 24 months
- Eyeglass lenses - Once every 12 month
- Contact lenses – Once every 12 months; contact lens benefit is not available in the same year that frames and lenses are purchased.
- Laser vision surgery - Discounts available through network providers. Go to VSP website for more information.
- Discounts - Available for frames, lenses and contacts if purchased in-network more often than benefit frequency. See www.vsp.com for more information.
Submitting a Claim
If a vision claim for services or materials is obtained through an out-of-network provider, you will need to pay the entire bill at the time of service and submit a claim for reimbursement to VSP. Out-of-network claims must be submitted to VSP within six months from the date of service.
Vision Benefits Summary |
|
| In-Network Provider | |
Eye Exam (Every 12 months) |
Plan pays 100% (after $20 copay) |
Eyeglass Lenses (Every 12 months) |
100% for single vision, lined bifocal or lined trifocal lenses (after $25 copay) |
Contact Lenses — Evaluation and fitting |
Plan pays up to $150 after $25 copay |
Eyeglass Frames (Every 24 months) |
Plan pays up to $150 allowance after $25 copay |
Laser Correction Surgery |
Plan provides discount |
| Out-of-Network Provider *(If you decide to see a non-VSP provider, call 1-800-877-7195.) |
|
Eye Exam |
Plan pays up to $35 allowance |
Eyeglass Lenses |
Plan pays up to $25 for single vision |
Contact Lenses — Evaluation and fitting |
Plan pays up to $105 |
Eyeglass Frames |
Plan pays up to $45 allowance |
Laser Correction Surgery |
Not covered |
Vision Service Rates Per Month |
|
VSP Plan |
Employee Cost |
Employee Only |
$10.94 |
Employee + Spouse/Domestic Partner |
$17.18 |
Employee + Child(ren) |
$17.51 |
Family |
$28.25 |