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: 30010861
Effective Date: 01/01/2022
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
$10 copay
Materials
$25 copay
Single Vision Lenses
$0 after $25 copay
Bifocal Lenses
$0 after $25 copay
Trifocal Lenses
$0 after $25 copay
Frames
Coverage limited to $150
Contacts (in lieu of glasses)
Coverage limited to $150
Frequency
Exams
Once every 12 months
Lenses
Once every 12 months
Frames
Once every 24 months
Contacts
Once every 12 months
Out-of-Network
Exams
Up to $45 reimbursement after $10 copay
Materials
$25 copay
Single Vision Lenses
Up to $30 reimbursement after $10 copay
Bifocal Lenses
Up to $50 reimbursement after $10 copay
Trifocal Lenses
Up to $65 reimbursement after $10 copay
Frames
Up to $70 reimbursement after $10 copay
Contacts (in lieu of glasses)
Coverage limited to $105
Frequency
Exams
Once every 12 months
Lenses
Once every 12 months
Frames
Once every 24 months
Contacts
Once every 12 months