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Vision
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.
VSP Vision (SISC)
Signature
In-Network
Out-Of-Network
Plan Pays Up To:
WellVision Exam
Retinal Screening
$15 copay
Additional $39 copay
$45
Frequency
1 x every 12 months
In-network limitations apply
Lenses
Plan Pays Up To:
Single Vision Lens
Combined with exam
$45
Bifocal Lens
Combined with exam
$65
Trifocal Lens
Combined with exam
$85
Frequency
1 x every 12 months
In-network limitations apply
Frames
Plan Pays Up To:
Benefit
$120 allowance for most selection of
frames
$47
$140 allowance for featured frame
brands
$65 Costco frame allowance
Frequency
1 x every 24 months
In-network limitations apply
Lens Enhancements
Standard Progressive
Premium Progressive
Custom Progressive
$50 copay
$80-$90 copay
$120-160 copay
Plan Pays Up To:
$85
Contacts (Elective)
Plan Pays Up To:
Benefit
$105 allowance for contacts & contact
lens exam
Up to $105
Frequency
1 x every 12 months
1 x every 12 months
The information in this booklet is a general outline of the benefits offered under College of Marin benefits program. This booklet may not include all relevant limitations and conditions.
Specific details and limitations are provided in the plan documents, which may include a Summary of Plan Description (SPD), Evidence of Coverage (EOC), and/or insurance policies. The
plan documents contain relevant plan provisions. If the information in this booklet differs from the plan documents, the plan documents will prevail.