VSP LVISN1 PLAN
  In Network Out of Network
Eye Exams
Once every 12 months
$40 maximum allowance
plus 20% discount
$40 maximum reimbursement
Single Vision Lenses
Once every 12 months
$35 maximum allowance
plus 20% discount
$35 maximum reimbursement
Bifocal Lenses
Once every 12 months
$45 maximum allowance
plus 20% discount
$45 maximum reimbursement
Trifocal Lenses
Once every 12 months
$60 maximum allowance
plus 20% discount
$60 maximum reimbursement
Lenticular Lenses
Once every 12 months
$150 maximum allowance
plus 20% discount
$150 maximum reimbursement
Frames
Once every 24 months
$40 maximum allowance $40 maximum reimbursement
Contacts (instead of glasses)
Once every 12 months
Elective: $55 maximum allowance
(includes contacts and contact lens exam)
plus 15% discount on contact lens exam
Elective: $55 maximum reimbursement