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.
VSP Vision Plan
Plan Information
Plan Name: VSP Vision
Policy Number: 30083694
Effective Date: 07/01/2024
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
Single Vision Lenses
$0 after $25 Prescription Glasses Copay
Bifocal Lenses
$0 after $25 Prescription Glasses Copay
Trifocal Lenses
$0 after $25 Prescription Glasses Copay
Frames
$150 Allowance
Contacts (in lieu of glasses)
$130 Allowance
Frequency
Exams
Once every 12 months
Lenses
Once every 12 months
Frames
Once every 24 months
Contacts
Once every 12 months
Out-of-Network
Get the most out of your benefits and greater savings with a VSP network doctor. Call member services for out of network plan details.
Plan Documents
Contact Information
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
Single Vision Lenses
$0 after $25 Prescription Glasses Copay
Bifocal Lenses
$0 after $25 Prescription Glasses Copay
Trifocal Lenses
$0 after $25 Prescription Glasses Copay
Frames
$150 Allowance
Contacts (in lieu of glasses)
$130 Allowance
Frequency
Exams
Once every 12 months
Lenses
Once every 12 months
Frames
Once every 24 months
Contacts
Once every 12 months
Out-of-Network
Get the most out of your benefits and greater savings with a VSP network doctor. Call member services for out of network plan details.