Vision care is an important part of your overall health. Vision care benefits are provided by Vision Service Provider (VSP) Vision Care using their Choice Network of providers.
You may go to any vision care provider, but when you use a VSP provider, you pay a copayment at the time of service and do not have to file a claim. If you use a non-VSP network provider VSP will only reimburse the allowed amount which may be less than what the non-network provider charges. You are responsible for the difference.
|Vision Care||Coverage||Cost When Using a VSP Provider|
|Vision exam||Once every calendar year||Plan pays 100%*|
|Lenses||Once every calendar year. Includes basic, lined bifocal and lined trifocal lenses. $40 copay for progressive lenses.||Plan pays 100%*|
|Frames||Once every calendar year||Plan pays 100%, up to $150 retail value*|
|Elective contact lenses||Once every calendar year in lieu of frames and lenses||Professional fees and materials covered up to $150|
*Subject to a $25 copayment for all services combined.
Plan Contribution Rates
|Employee & Spouse/Registered Domestic Partner||$8.99||0.00||$8.99|
|Employee & Child(ren)||$9.18||0.00||$9.18|
|Employee & Family||$14.79||0.00||$14.79|
Medical & Urgent Eye Care
The vision plan includes a primary eye care benefit for medical and urgent eye care.
This benefit includes:
- Treatment for eye or pain conditions like pink eye
- Tests to diagnose sudden vision changes, detect and track eye conditions such as glaucoma and diabetic eye disease
- Exams to monitor cataracts
- Medically necessary contact lenses for certain diagnosed conditions, as defined by VSP, are covered at 100%, subject to a $25 copay, once every calendar year
Out of Country Access
For services received outside the U.S., members will be reimbursed according to the out-of-network schedule. Members will need to pay for the services at the time of service and submit a request for reimbursement. The reimbursement request needs to include a detailed description of the services received. VSP advises members to use the Member Reimbursement Form available on vsp.com. Members will be reimbursed in U.S. dollars based on the currency exchange rate at the time of service. Members are not required to convert foreign currency into U.S. dollars.