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 Information
Plan Name: VSP Vision
Policy Number: 12135824
Effective Date: 01/01/2025
Network: Vision Service Plan
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
Materials
$20 copay
Single Vision Lenses
No charge after applicable copay
Bifocal Lenses
No charge after applicable copay
Trifocal Lenses
No charge after applicable copay
Frames
Coverage limited to $120 then plan pays 20% off remaining balance
Contacts (in lieu of glasses)
Coverage limited to $120
Frequency
Exams
Once every 12 months
Lenses
Once every 12 months
Frames
Once every 24 months
Contacts
Once every 12 months
Out-of-Network Reimbursement
Exams
Reimbursed up to $50
Materials
Reimbursed up to benefit schedule after $20 copay
Single Vision Lenses
Reimbursed up to $50 after applicable copay
Bifocal Lenses
Reimbursed up to $75 after applicable copay
Trifocal Lenses
Reimbursed up to $100 after applicable copay
Frames
Reimbursed up to $70
Contacts (in lieu of glasses)
Reimbursed up to $105 (applies to exam and contact lenses)
Frequency
Exams
Once every 12 months
Lenses
Once every 12 months
Frames
Once every 24 months
Contacts
Once every 12 months
Plan Documents
Coming Soon!