The Vision plan pays the highest benefits when you use VSP-affiliated providers. To minimize your out-of-pocket costs, be sure to stay in the VSP network.
|
Vision Plan at a Glance |
||
|---|---|---|
|
Plan Provision |
In-Network |
Out-of-Network |
|
Exam |
||
|
Vision |
You pay $10 copay |
$45 allowance |
|
Contacts |
You pay $60 copay |
$45 allowance |
|
Lenses |
||
|
Single |
You pay $25 copay |
$30 allowance |
|
Lined Bi-focal |
You pay $25 copay |
$50 allowance |
|
Lined Tri-focal |
You pay $25 copay |
$65 allowance |
|
Frames |
||
|
$130 allowance
|
$70 allowance |
|
|
Frequency |
||
|
Exam |
Every 12 months |
|
|
Lenses |
Every 12 months |
|
|
Frames |
Every 24 months |
|
* If you use a non-VSP-affiliated provider, you may be eligible for a small allowance as shown in this chart and will be responsible for all remaining charges.