Vision Plan

Vision coverage is available to you through Vision Service Plan (VSP), a vision service provider that specializes in providing choice, value and quality products and services.

This plan allows you to receive a complete eye examination and materials. VSP's Advantage Network consists of private optometrists, opticians, ophthalmologists, and retailers. You may choose to receive care from a VSP participating provider (in-network) or from any other doctor of your choosing (out-of-network).

Dollar for dollar, you get the best value from your benefits when you visit a participating VSP doctor or retail service provider. If you decide not to see a VSP doctor, you will typically receive a lesser benefit, pay more out-of-pocket and need to submit reimbursement form for applicable services.

Vision Plan Documents

Benefit Summary

Certificate of Coverage

VSP ADVANTAGE PLAN	IN-NETWORK	OUT-OF-NETWORK (MAXIMUM ALLOWANCE)
Frequency of Services: Vision Exam Lenses Frames Contact Lenses*	Every 12 months Every 12 months Every 24 months Every 12 months	Every 12 months Every 12 months Every 24 months Every 12 months
Vision Exam	$10 copay	Up to $40 allowance
Standard Plastic Lenses (per pair): Single Vision Bifocal Trifocal Standard Progressives Premium Progressives	$15 copay $15 copay $15 copay Covered in full $95 - $105 copay	Up to $30 allowance Up to $50 allowance Up to $60 allowance Up to $50 allowance Up to $50 allowance
Frames: Retail Featured Brand	$130 allowance $180 allowance	Up to $50 allowance
Contact Lenses*: Conventional or Disposable Medically Necessary Lens Exam / Fitting	$135 allowance Covered in full Up to $60 allowance	Up to $100 allowance Up to $210 allowance Not covered

*Benefits apply to contact lenses OR prescription glasses, not both. ** A 20% discount will be applied to any amount exceeding the frame allowance.

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