| Benefit | In-Network |
|---|---|
| Wellvision Exam Copay | $10 per exam |
| Essential Medical Eye Care (medical diagnosis) | $20 per exam |
| Exam Allowance (once every 12 months) | 100% after copay |
| Eyeglass Lenses Allowances (one pair every 12 months) | |
| Single Vision Lenses | 100% after $25 copay |
| Bifocal Lenses | 100% after $25 copay |
| Trifocal Lenses | 100% after $25 copay |
| Frame Retail Allowance (one every 12 months) | |
| Frames | Up to $150, after $25 copay |
| Contact Lenses Allowances (every 12 months, in lieu of Frames) | |
| Elective Contact Lenses | Covered up to $150, up to $60 copay |
| Therapeutic Contact Lenses | Covered 100% |
Pay less with in-network providers
When you use vision providers outside the VSP network, you are responsible for paying upfront and will be reimbursed for only part of the expense.
Semi-Monthly Rates
| Benefit plan | Employee | Employee + Spouse/DP |
Employee + Child(ren) |
Family |
|---|---|---|---|---|
| VSP Vision Plan | $2.00 | $3.00 | $3.00 | $5.00 |
