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VISION

Voluntary Vision Plan
Services In-Network Out-of-Network
Routine Eye Exam $10 copay Up to $46 allowance
  One every 12-months
Eyeglass Frames $120 allowance + 20% off balance Up to $47 allowance
  One every 24-months
Eyeglass Lenses $25 copay Up to $47 allowance
  Every 12-months instead of eyeglasses
Contact Lenses $120 allowance Up to $120 allowance
  Every 12-months instead of eyeglasses
Elective Conventional $120 allowance Up to $120 allowance
  Every 12-months instead of eyeglasses
Elective Disposable $120 allowance Up to $120 allowance
  Every 12-months instead of eyeglasses
Non-elective
(medically necessary)		 Covered in full Up to $210 allowance
  Every 12-months instead of eyeglasses
Vision

www.vsp.com

877-814-8970

Resources

Employee Level Bi-Weekly Rate
Employee $4.25
Employee + Spouse $7.15
Employee + Child(ren) $7.20
Family $11.50