VSP LVISN1 PLAN

VSP Discount plan

 

In Network

Out of Network

In Network

Eye Exams
Once every 12 months

$40 maximum allowance
plus 20% discount

$40 maximum reimbursement

20% discount

Single Vision Lenses
Once every 12 months

$35 maximum allowance
plus 20% discount

$35 maximum reimbursement

20% discount

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

15% discount