This benefit helps pay for annual vision examinations and for glasses and contact lenses, subject to the rules of the Plan. The Plan uses a network of opticians, optometrists, and ophthalmologists called Vision Service Plan (VSP) to provide these benefits in an efficient and cost-effective way. Reduced benefits are available when you use a provider outside the VSP network. How often you can use the benefit and your copayment are shown in the benefit schedules below.
Summary of Benefits
VSP Doctor Out-Of-Network Vision Exam - Every calendar year Covered in full Up to $35 Frame - Every two calendar years Covered up to $175 retail value Up to $35 Lenses - Every calendar year: Single vision Covered in full Up to $30/pair Lined bifocal Covered in full Up to $40/pair Lined trifocal Covered in full Up to $55/pair Contacts Covered up to $175/pair for exam, fitting, evaluation and lenses Up to $100/pair for exam, fitting, evaluation and lenses Safety Glasses - Every two years
Covered In Full Not Covered