TraditionalPlan

Resources



In-Network Coverage


WellVision Eye Exam
Once every 12-months receive a WellVision Eye Exam for a $15 Co-Pay.

Retinal Screening
Once every 12-months receive a Routine Digital Retinal Screening for up to a maximum $39 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, Light-Reactive Lenses or Standard Progressive (No-Line) Lenses for Freeafter 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, and 35-40% Discounts on High Index, Polarized & Impact-Resistant Lenses.

Lens Enhancements
Polycarbonate Lenses for Kids are Free. Tinting, Transitional (Photochromic), Polycarbonate Lenses for Adults, Anti-Glare Coating, Edge Polishing, Scratch-Resistant Coating, Tinting & UV Protection are Discounted 35-40%.

Frames
Once every 24-months spend up to $120 and receive a 20% Discount for amounts over that. Choose a Featured Frame Brand and get an extra $20 to spend, for a total allowance of $140.

Extra Savings
20% Discount on additional glasses including lens enhancements, or non-prescription sunglasses or blue-light filtering glasses within 12-months of last eye exam.

Contact Lenses
Instead of Lenses and/or Frames, once every 12-months spend up to $120 on Elective Contact Lenses. Additionally, once every 12-months receive a 15% Discount on a Contact Lens Fitting & Evaluation Exam, the cost of which reduces the amount available for Contact Lenses. Medically Necessary Contact Lenses are Free. Note: Purchase of Contact Lenses resets the 24-month waiting period for Frames.

Essential Medical Eye Care
For a $20 Co-Pay, receive:
• Retinal Screening for members with diabetes.
• Medical Exams & Services for diagnosis, treatment, & management of chronic conditions, such as diabetic eye disease, glaucoma, & age-related macular degeneration.
• Treatment for Urgent Conditions such as eye infections, foreign body & abrasions, eye injuries, & eye or eyelid chemical exposure.
• Medical Tests for diagnosis & treatment of sudden vision changes, such as eye flashes, floaters, & sudden vision loss.
• Other Vision Medical Services

Laser Vision Care
Laser Vision Surgery from in-network providers is Discounted for an average 15% off the regular price, or 5% off the promotional price.

TruHearing
Save up to 60% on top of the line hearing aids. Free, fast online hearing screening. Get 120 hearing aid batteries for only $39.



Out-of-Network Coverage


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 using the Out-of-Network Reimbursement Form. 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 Bifocal Lenses
$100  Lined Trifocal Lenses
$125  Lenticular Lenses
$  75  Progressive Lenses
$  70  Frames
$105  Elective Contact Lenses
$    5  Tints



Monthly Rates


Employer Sponsored Rates are for when employees pay less than 50% of the premium
Voluntary (Employee Paid) Rates are for when employees pay more than 50% of the premium

TraditionalPlan
       Employer            Voluntary
Sponsored (Employee Paid)
Member   7.74 9.74
Member & Spouse 13.48 14.98
Member & Child(ren) 13.98 14.98
Family 23.74 23.74


TraditionalPlan
with Comprehensive Progressive Lens Coverage
       Employer            Voluntary
Sponsored (Employee Paid)
Member   8.74 10.74
Member & Spouse 14.98 16.48
Member & Child(ren) 15.48 16.98
Family 26.48 26.74


TraditionalPlan
with Computer VisionCare Coverage
       Employer            Voluntary
Sponsored (Employee Paid)
Member 9.74 11.98
Member & Spouse 15.48 16.98
Member & Child(ren) 15.98 17.48
Family 25.74 26.24


TraditionalPlan
with Comprehensive Progressive Lens & Computer VisionCare Coverage
       Employer            Voluntary
Sponsored (Employee Paid)
Member 11.24 13.48
Member & Spouse 17.98 18.98
Member & Child(ren) 18.48 19.48
Family 30.24 30.24