Vision
Healthy eyes and clear vision are an important part of your overall health and quality of life. You may enroll yourself and your eligible dependents or you may waive vision coverage. You do not have to be enrolled in medical coverage to elect vision coverage or cover the same dependents under medical and vision.
Although vision care services and supplies are covered in-network and out-of-network, your benefits are generally greater when you use in-network providers. Your costs are based on the family members you choose to cover.
Plan Information
Plan Name: VSP Vision
Policy Number: 12108463
Effective Date: 01/01/2025
Provider Network: VSP
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
In-Network
Exams
None / Materials: $20 copay
Single Vision Lenses
No charge after materials copay
Bifocal Lenses
No charge after materials copay
Trifocal Lenses
No charge after materials copay
Frames
Coverage limited to $140 “featured frame” or $120 after materials copay
Contacts (in lieu of glasses)
Coverage limited to $120 (separate exam/fitting copay, never to exceed $60)
Frequency
Exams
Once every 12 months
Lenses
Once every 12 months
Frames
Once every 24 months
Contacts
Once every 12 months
Out-of-Network Reimbursement
Exams
Up to $50
Single Vision Lenses
Up to $50 after materials copay
Bifocal Lenses
Up to $75 after materials copay
Trifocal Lenses
Up to $100 after materials copay
Frames
Up to $70 after materials copay
–
Contacts (in lieu of glasses)
Up to $105
–
Frequency
Exams
Once every 12 months
Lenses
Once every 12 months
Frames
Once every 24 months
Contacts
Once every 12 months