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Vision - VSP
Routine vision exams are important, not only for correcting vision but because they can detect other serious
health conditions.
We offer you a vision plan through Vision Service Plan.
Base Plan
Buy-Up Plan
With a VSP doctor
With a VSP doctor
Exam Copay
$0
$0
Materials Copay
$0
$0
Frames
$130 Retail Allowance
$180 Retail Allowance
Lenses
Single Lenses
Covered in Full
Covered in Full
Bifocal Lenses
Covered in Full
Covered in Full
Trifocal Lenses
Covered in Full
Covered in Full
Contact Lenses
Elective
$130 Retail Allowance
$180 Retail Allowance
Medically Necessary
Covered in Full
Covered in Full
Frequency
Exam
12 months
12 months
Lenses
12 months
12 months
Contact Lenses²
12 months¹
12 months³
Frames
12 months
12 months
Lens Options
Not Covered
Covered
Tints/Photochromic Lenses
Out-Of-Network Allowances
¹
Contact lenses are in lieu of lenses and frame.
² Fitting and evaluation-standard or premium fit not to exceed $60 copay, 15% discount for fitting and evaluation will apply.
³ Contact lens rider allows for contacts every 12 months (50 copay), even if frames and lenses are also purchased every 12 months.
Exam
…………………………... Up to $45.00
Frame
…………………………... Up to $70.00
Single vision lenses
…………………………... Up to $30.00
Lined bifocal lenses
…………………………... Up to $50.00
Lined trifocal lenses
…………………………... Up to $65.00
Contacts, Medically Necessary …………………………... Up to $210.00