
| Carrier: VSP (Vision Service Plan) | ||
| Network: Signature | ||
| Customer Service: 800 877 7195 | ||
| Website: www.vsp.com |
| Once every 12-months receive a WellVision Eye Exam for a $10 Co-Pay. |
| Once every 12-months receive a Routine Digital Retinal Screening for up to a maximum $39 Co-Pay |
| Once every 12-months pay $25 for Lenses and/or Frames. |
| Once every 12-months receive Single, Lined-Bifocal, Lined-Trifocal, Light-Reactive Lenses or Standard Progressive (No-Line) Lenses for Free. | ||
| Receive Premium Progressive Lenses for a $80-$90 Co-Pay, or Custom Progressive Lenses for a $120-$160 Co-Pay. | ||
| Or, get 35-40% Discounts on High Index, Polarized & Impact-Resistant Lenses. |
| Tinting, Transitional (Photochromic), Polycarbonate Lenses for Kids & Adults are Free. | ||
| Anti-Glare Coating, Edge Polishing, Scratch Resistant Coating, Tinting & UV Protection are Discounted 35-40%. |
| Once every 12-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. |
| 20% Discount on additional glasses including lens enhancements, or non-prescription sunglasses or blue-light filtering glasses within 12-months of last eye exam. |
| Instead of Lenses and/or Frames. | ||
| $120 to spend towards the cost of Contact Lenses once every 12-months. | ||
| 15% Discount, with a $60 maximum cost for a Contact Lens Fitting & Evaluation once every 12-months. | ||
| The Contact Lens Fitting & Evaluation does not count against the amount available to be spent on Contact Lenses. | ||
| Medically Necessary Contact Lenses are Free. | ||
| Note: Purchase of Contact Lenses resets the 12-month waiting period for Lenses & Frames. |
| For a $20 Co-Pay, receive: | ||||
| Retinal Screenings 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 Surgery from in-network providers is Discounted for an average 15% off the regular price, or 5% off the promotional price. |
| Save up to 60% on top of the line hearing aids. | ||
| Free, fast online hearing screening. | ||
| Get 120 hearing aid batteries for only $39. |
| 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 |
| Current & Former Employee Coverage & Rates for the 2025/26 Plan Year, effective 7/1/2025 through 6/30/2026. |
| 7.74 | Member | ||
| 7.22 | Child | ||
| 7.22 | Children | ||
| 6.80 | Spouse | ||
| 18.44 | Spouse & Child | ||
| 18.44 | Spouse & Children |