ClassicPlan
Resources
» Find a VSP Signature Network Vision Doctor
» Plan Contracting Kit
» Plan Brochure
» Glosary of Terms
» Member Enrollment Form
» Member Flyer - Provider Network
» Member Flyer - Get the Most of Your Benefit
» Member Flyer - See Well Stay Health
» Out-of-Network Reimbursement Form
Coverage Details
WellVision Exam
Once every 12-months receive a WellVision Exam for a $15 Co-Pay.
Materials Deductible
Once every 12-months pay a $25 Deductible for Lenses and/or Frames.
Lenses
Once every 12-months receive Single, Lined-Bifocal, Lined-Trifocal or Standard Progressive (No-Line) Lenses for Free after the Materials Deductible, if not already met. Or, receive Premium Progressive Lenses for an $80-$90 Co-Pay, or Custom Progressive Lenses for a $120-$160 Co-Pay after the Materials Deductible, if not already met.
Lens Customizations
Polycarbonate Lenses for Kids are Free. Tints, Dyes, Photochromic & Polycarbonate Lenses for Adults are Discounted. Scratch-Resistance, Anti-Reflective Coatings and other Lens Customizations are Discounted.
Frames
Once every 12-months spend up to $120 and receive a 20% Discount for amounts over that, after the Materials Deductible, if not already met. For additional glasses or sunglasses receive a 20% Discount.
Contact Lenses
Instead of Lenses and/or Frames, once every 12-months spend up to $120 on Contact Lenses. Additionally, once every 12-months receive a 15% Discount on a Contact Lens Fitting & Evaluation, without reducing the amount available for Contact Lenses. Note: Purchase of Contact Lenses resets the 24-month Frames waiting period.
ValueAdd Programs
Laser Vision Correction is Discounted. Diabetic EyeCare Plus provides follow-up medical care for Members with Type I or II Diabetes. TruHearing offers 20% Discount for Digitial Hearing Aids. Visit www.vsp.com for more details on all 3 programs.
Out-of-Network Coverage
Out-of-Network Reimbursement Form
Members can utilize out-of-network providers, but they will be required to pay the provider in full at the time of service. Members can then apply for a partial reimbursement directly from VSP. Claims must be filed within 6-months of the date of service. Members may receive the following reimbursement allowances for out-of-network services after any applicable co-pays or deductibles:
$ 50 Exam
$ 50 Single Vision Lenses
$ 75 Lined Bifocial Lenses
$100 Lined Trifocal Lenses
$125 Lenticular Lenses
$ 75 Progressive Lenses
$ 70 Frames
$105 Elective Contact Lenses
$ 5 Tints
Monthly Rates
Use Employer Sponsored rates when employees pay less than 50% of the premium
Use Voluntary (Employee Paid) rates when employees pay more than 50% of the premium
ClassicPlan
| Employer | Voluntary | |||
| Sponsored | (Employee Paid) | |||
| Member | 8.24 | 11.24 | ||
| Member & Spouse | 14.48 | 16.98 | ||
| Member & Child(ren) | 14.98 | 17.48 | ||
| Family | 25.24 | 27.98 |
ClassicPlan
with Comprehensive Progressive Lens Coverage
| Employer | Voluntary | |||
| Sponsored | (Employee Paid) | |||
| Member | 9.48 | 12.98 | ||
| Member & Spouse | 15.98 | 19.24 | ||
| Member & Child(ren) | 16.48 | 19.74 | ||
| Family | 28.24 | 30.98 |
ClassicPlan
with Computer VisionCare Coverage
| Employer | Voluntary | |||
| Sponsored | (Employee Paid) | |||
| Member | 10.24 | 13.48 | ||
| Member & Spouse | 16.48 | 19.74 | ||
| Member & Child(ren) | 16.98 | 19.74 | ||
| Family | 27.48 | 29.98 |
ClassicPlan
with Comprehensive Progressive Lens & Computer VisionCare Coverage
| Employer | Voluntary | |||
| Sponsored | (Employee Paid) | |||
| Member | 11.24 | 14.98 | ||
| Member & Spouse | 17.98 | 21.24 | ||
| Member & Child(ren) | 18.48 | 21.74 | ||
| Family | 30.48 | 32.98 |