Vision

VSP 12 Month Plan

Benefit	Description	Copay	Frequency
Your Coverage with VSP Doctors and Affiliate Providers*
WellVision Exam	Focuses on your eyes and overall wellness	$0	Every plan year
Prescription Glasses		$0	See frame and lenses
Frame	$130 allowance for a wide selection of frames $150 allowance for featured frame brands 20% savings on the amount over your allowance	Included in Prescription Glasses	Every plan year
Lenses	Single vision, lined bifocal and lined trifocal lenses Polycarbonate lenses for dependent children	Included in Prescription Glasses	Every plan year
Lens Enhancements	Standard progressive lenses Premium progressive lenses Custom progressive lenses Average savings of 20-25% on other lens enhancements UV Protection Scratch Resistance Coating Tints	$55 $95 – $105 $150 – $175 $0 $0 $0	Every plan year
Contacts (instead of glasses)	$130 allowance for contacts; copay does not apply Contact lens exam (fitting and evaluation)	$0	Every plan year
Diabetic Eyecare Plus Program	Services related to diabetic eye disease, glaucoma and age-related macular degeneration (AMD). Retinal screening for eligible members with diabetes. Limitations and coordination with medical coverage may apply. Ask your VSP doctor for details.	$20	As needed
Extra Savings	Glasses and Sunglasses20% savings on additional glasses and sunglasses, including lens enhancements, from any VSP doctor within 12 months of your last WellVision Exam. Laser Vision CorrectionAverage 15% off the regular price or 5% off the promotional price; discounts only available from contracted facilities

VSP 24 Month Plan

Benefit	Description	Copay
Your Coverage with VSP Doctors and Affiliate Providers*
WellVision Exam	Focuses on your eyes and overall wellness Children to age 19 every plan year Adults Every other plan year*	$0
Prescription Glasses		$0
Frame	$130 allowance for a wide selection of frames $150 allowance for featured frame brands 20% savings on the amount over your allowance Children to age 19 every plan year Adults Every other plan year	Included in Prescription Glasses
Lenses	Single vision, lined bifocal and lined trifocal lenses Polycarbonate lenses for dependent children Children to age 19 every plan year Every other plan year	Included in Prescription Glasses
Lens Enhancements	Tints/Photochromic adaptive lenses Scratch-resistant coating UV protection Standard progressive lenses Premium progressive lenses Custom progressive lenses Average savings of 20-25% on other lens enhancements Children to age 19 every plan year Adults Every other plan year	$55 $95 – $105 $150 – $175 $0 $0 $0
Contacts (instead of glasses)	$130 allowance for contacts; copay does not apply Contact lens exam (fitting and evaluation) Children to age 19 every plan year Adults every other plan year	$0
Additional Coverage	Diabetic Eyecare Plus Program
Extra Savings	Glasses and Sunglasses20% savings on additional glasses and sunglasses, including lens enhancements, from any VSP doctor within 12 months of your last WellVision Exam. Extra $20 to spend on featured frame brands. Go to vsp.com/specialoffers for details Laser Vision CorrectionAverage 15% off the regular price or 5% off the promotional price; discounts only available from contracted facilities Retinal Screening No more than a $39 copay on routine retinal screening as an enhancement to a WellVision Exam.