VSP VISION PLAN

 

In Network

Out of Network

Eye Exams
Once every calendar year

Plan pays 100%

$35 maximum reimbursement

Single Vision Lenses
Once every calendar year

$25 copay

$25 maximum reimbursement

Bifocal Lenses
Once every calendar year

$25 copay

$40 maximum reimbursement

Trifocal Lenses
Once every calendar year

$25 copay

$55 maximum reimbursement

Lenticular Lenses
Once every calendar year

$25 copay

$80 maximum reimbursement

Frames
Once every calendar year

$25 copay
(up to a $140 retail allowance)

$40 maximum reimbursement

Contacts (instead of glasses)
Once every calendar year

Elective: up to a $125 maximum
(includes contacts and contact lens exam)

Elective: up to $105 maximum reimbursement