Benefit

General Description

Eye

Examination

VSP offers a thorough eye exam covered in full, less any applicable plan copayment, when services are obtained from a VSP network doctor.

Materials

Lenses: VSP’s standard lenses are covered in full (less any applicable plan copayment), including glass or plastic single vision, bifocal, trifocal or other more complex lenses necessary for the patient's visual welfare.

Frames: VSP provides a frame allowance of $130 retail equivalent, giving patients full coverage for 14,000 frames on the market today. If the patient selects a frame that exceeds the plan allowance, VSP offers a 20% discount off the amount over the retail allowance.

Contact lenses: Covered in full up to $130 allowance, applied to the contact lens exam (fitting and evaluation) and lenses. Our special program provides current soft contact lens wearers who qualify with a covered-in-full contact lens evaluation^[1] and initial supply of non-specialty replacement lenses from VSP’s list of popular brands. VSP doctors also provide a 15% discount off their professional services for prescription contact lenses.

Lens

Options

To ensure added value, VSP controls the cost of non-covered spectacle lens options. All VSP network doctors must adhere to our patient options price list, which VSP sets and controls. On a national average, we achieve a savings of approximately 30% below usual and customary. It is important to note that VSP's Signature Plan fully covers Polycarbonate lenses for children.

Valuable Discounts

As an added benefit VSP provides:

·         20% off additional pairs of prescription and non-prescription glasses, including sunglasses^[2]

·         15% off professional contact lens services^[3]

·         15-20% off (average) laser vision correction through contracted laser centers

Low Vision

Members with severe visual problems are eligible for this benefit, which can include supplemental testing, low vision prescription services, evaluations, optical and non-optical aids and training. If low vision supplemental testing is approved, VSP will pay up to a maximum of $125 every two years. If low vision aids are approved, VSP will pay 75% of the approved amount up to a maximum of $1,000 per covered individual (less any amount paid for supplemental testing) every two years.

Exclusions

The following items are excluded under this plan:

·         plano lenses (non-prescription)

·         two pairs of glasses instead of bifocals

·         replacement of lenses, frames or contacts

·         medical or surgical treatment

·         orthoptics, vision training or supplemental testing

Items not covered under the contact lens coverage:

·         corneal refractive therapy or orthokeratology

·         insurance policies or service agreements

·         artistically painted lenses

·         additional office visits for contact lens pathology

·         contact lens modification, polishing or cleaning

Out-of-Network Schedule of Allowances

Although more than 95% of our patients see VSP network doctors, we believe that choice is essential when it comes to health care. That's why VSP provides the following reimbursement schedule for patients choosing a non-VSP provider.

Eye examination

$46

Trifocal lenses

$95

Single vision lenses

$55

Frame

$50

Bifocal lenses

$75

Contact lenses

$105