Vision Coverage
Annual vision exams are an important part of managing your overall health. Vision exams can help to identify certain medical conditions such as diabetes or high cholesterol. To help you manage your health, we offer vision coverage through Sample Provider. Under this plan, you may use the eye care professional of your choice. However, when you use a participating network provider, you receive higher levels of coverage.
Our vision benefits are provided by SAMPLE. You have the option of using a SAMPLE or a Non-SAMPLE provider each time you obtain vision services, but a higher level of benefits will be received if you go to a SAMPLE provider.
| VSP Vision Plan | ||
|---|---|---|
| IN-NETWORK | OUT-OF-NETWORK | |
| Eye Exam (Once every 12 months) | ||
| Eye Exam | Covered in full after a $10 copay | Plan pays up to $45 after a $10 copay |
| Lenses (Once every 12 months) | ||
| Single | Covered in full after a $25 copay | Plan pays up to $30* |
| Bifocal | Covered in full after a $25 copay | Plan pays up to $50* |
| Trifocal | Covered in full after a $25 copay | Plan pays up to $65* |
| Lenticular | Covered in full after a $25 copay | Plan pays up to $100* |
| Frames (Once every 12 months) | ||
| Plan pays up to $130* | Plan pays up to $70* | |
| Contact Lenses (in lieu of lenses and frames once every 12 months) | ||
| Elective | Plan pays up to $130 | Plan pays up to $105 |
| * A $25.00 copayment is payable at the time the materials are ordered. | ||