VSP (Vision Service Plan)
www.vsp.com

Benefit Coverage with a VSP Doctor Description Co-Pay
WellVision Exam      - Focuses on your eyes and overall wellness
     - Every 12 months
$10
Prescription Glasses   $25
Frame      - $130 allowance for a wide selection of frames
     - 20% off amount over your allowance
     - Every 24 months
Included in Prescription
Glasses
 
Lenses
    
     - Single vision, lined bifocal, and lined trifocal lenses
     - Polycarbonate lenses for dependent children
     - Every 24 months
Included in Prescription
Glasses
Lens Options      - Standard progressive lenses
     - Premium progressive lenses
     - Custom progressive lenses
     - Average 35-40% off other lens options
$50
$80 - $90
$120 - $160
Contacts (instead of glasses)   $0
Contacts      - $130 allowance for contacts and contact lens exam (fitting and evaluation)
     - 15% off contact lens exam (fitting and evaluation)
     - Every 24 months
 
Extra Savings and Discounts  
Glasses and Sunglasses      - 30% off additional glasses and sunglasses, including lens options, from the same
       VSP doctor on the same day as your WellVision Exam. Or get 20% off from any
       VSP doctor within 12 months of your last WellVision Exam
Retinal Screening      - Guaranteed pricing on retinal screening as an enhancement to your WellVision
       Exam
Laser Vision Correction      - Average 15% off the regular price or 5% off the promotional price; discounts
       only available from contracted facilities
     - After surgery, use your frame allowance (if eligible) for sunglasses from any VSP
       doctor
Your Coverage with Other Providers
Visit vsp.com for details, if you plan to see a provider other than a VSP doctor.
Exam...................................up to $50
Frame..................................up to $70
Single Vision Lenses.............up to $50
Lined Bifocal Lenses............up to $75
Lined Trifocal Lenses...........up to $100
Progressive Lenses..............up to $105
Contacts..............................up to $105

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