Vision Plans
The vision plan is administered by Vision Service Plan (VSP). Vision benefits are available on a voluntary basis for eligible employees and their dependents. Coverage includes benefits for eye examinations, lenses, frames and contact lenses. Additional discounts include Laser Vision Correction, prescription glasses with specialty lenses, prescription sunglasses and contacts. VSP’s provider network includes Costco, Walmart, Sam’s Club, Visionworks, and My Eye Dr.
Under the VSP Enhanced Plan, the second pair of glasses includes single vision, lined bifocal or trifocal, and standard progressive lenses covered in full after a $10 copay. In addition, there is an Enhanced Feature Frame Brand Allowance on the VSP Signature Plan, which allows members to receive an additional $50 to spend on featured frame brands.
Note: Employees will not receive ID cards for the vision plan.
How to Access Your VSP Benefit
Visit www.vsp.com or call 800-877-7195 and reference Group Number: 12305389.
| VSP Signature | VSP Enhanced | |||||||
|---|---|---|---|---|---|---|---|---|
| In-Network | Out-of-Network | In-Network | Out-of-Network | |||||
| Copays | ||||||||
| Routine Eye (WellVision) Exam | $10 copay | Reimbursable up to $52 | $10 copay | Reimbursable up to $52 | ||||
| Frames - VSP Network Doctors and Visionworks® Frames | $180 allowance; 20% off any remaining balance | Reimbursable up to $70 | $220 allowance; 20% off any remaining balance | Reimbursable up to $70 | ||||
| Covered Services – Lenses* | ||||||||
| Single Lenses | 100% after $10 copay | Reimbursable up to $55 | 100% after $10 copay | Reimbursable up to $55 | ||||
| Bifocal Lenses | 100% after $10 copay | Reimbursable up to $75 | 100% after $10 copay | Reimbursable up to $75 | ||||
| Trifocal Lenses | 100% after $10 copay | Reimbursable up to $100 | 100% after $10 copay | Reimbursable up to $100 | ||||
| Covered Services – Contact Lenses | ||||||||
| Contacts - Elective (Including fitting and evaluation) | $180 allowance. Contact lens exam copay up to $60 | Reimbursable up to $105 | $180 allowance | Reimbursable up to $105 | ||||
| Contacts – Medically Necessary | 100% after $10 copay | Reimbursable up to $210 | 100% after $10 copay | Reimbursable up to $210 | ||||
| Second Pair of Glasses or Contacts | • Not included |
• $10 copay for an allowance of $220 to spend on a second pair of glasses or contact lenses. • Includes single vision, lined bifocal, lined trifocal, and standard progressive contact lenses. |
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| Enhanced Featured Frame Brand |
• Additional $50 to spend on a selection of featured frame brands on top of frame allowance. |
• Additional $20 to spend on a selection of featured frame brands on top of frame allowance. |
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| Laser Vision Correction |
• Average 15% off the regular price or 5% off the promotional offer; discounts only available from VSP contracted facilities. • Members who’ve had laser surgery can use frame benefit for non-prescription sunglasses. |
• Average 15% off the regular price or 5% off the promotional offer; discounts only available from VSP contracted facilities. • Members who’ve had laser surgery can use frame benefit for non-prescription sunglasses. |
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| Benefit Frequency | ||||||||
| Routine Eye (WellVision) Exam | Every 12 months | Every 12 months | ||||||
| Frames | Every 12 months | Every 12 months | ||||||
| Lenses | Every 12 months | Every 12 months | ||||||
| Contact Lenses | Every 12 months | Every 12 months | ||||||
Vision Cost of Coverage
| Vision Service Plan (VSP) | Signature Plan | Enhanced Plan | ||
|---|---|---|---|---|
| Your Bi-monthly Deductions | ||||
| Employee Only | $5.48 | $14.16 | ||
| Employee + Family | $15.17 | $39.29 | ||
Lemek VSP Summary Signature Plan
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