
Over 22,800 participating providers
nationwide,
Patient pays only the selected co-payment for covered benefits.
You can choose any provider of vision care (see non-participating provider benefits).
VSP Doctor
Search
What are the Benefits?
You receive an Eye examination, Lenses/Frames
and Laser VisionCare Services according to the schedule of benefits you
purchase.
Choose from several co-payment
and
waiting period options:
Information effective 01-01-2008
VSP Vision A Plans (Rates Valid through
12/31/2009)
Plans with a 12 month Exam, 24 month Lenses, and 24 month Frame waiting
period *
|
Co Payment |
EE |
ES |
EC |
ESC |
| $20 exam/$25 materials co-pay | $6.40 | $10.20 | $10.40 | $16.70 |
$25 co-pay |
$9.30 | $14.80 | $15.10 | $24.30 |
$10 co-pay |
$9.80 | $15.70 | $16.00 | $25.80 |
No co-pay |
$12.70 | $20.20 | $20.60 | $33.30 |
VSP Vision
B Plans (Rates
valid through 12/31/2009)
Plans with a 12 month Exam, 12 month Lenses,
and 24 month Frame waiting period *
Co Payment |
EE |
ES |
EC |
ESC |
|
$10 exam/$25 materials co-pay |
$9.90 |
$15.80 |
$16.10 |
$25.90 |
$25 co-pay |
$10.60 |
$16.90 |
$17.20 |
$27.70 |
|
$10 co-pay |
$13.20 |
$21.20 |
$21.60 |
$34.80 |
No Co-pay |
$14.90 |
$23.80 |
$24.30 |
$39.10 |
|
Rates for Voluntary VSP Vision B Plans |
||||
Co Payment |
EE |
ES |
EC |
ESC |
|
$10 exam/$25 materials co-pay |
$11.50 |
$18.40 |
$18.70 |
$30.10 |
$25 co-pay |
$12.30 |
$19.60 |
$20.00 |
$32.20 |
|
$10 co-pay |
$15.40 |
$24.60 |
$25.10 |
$40.40 |
No Co-pay |
$17.30 |
$27.70 |
$28.20 |
$45.40 |
VSP Vision
C Plans (Rates
valid through 12/31/2009)
Plans with a 12 month Exam, 12 month
Lenses, and 12 month Frame waiting period *
Co Payment |
EE |
ES |
EC |
ESC |
|
$10 exam/$25 materials co-pay |
$11.90 |
$23.80 |
$25.50 |
$40.70 |
$25 co-pay |
$12.30 |
$24.50 |
$26.20 |
$41.80 |
|
$10 co-pay |
$14.00 |
$28.00 |
$30.00 |
$47.90 |
No Co-pay |
$15.60 |
$31.20 |
$33.30 |
$53.20 |
|
Rates for Voluntary VSP Vision C Plans |
||||
Co Payment |
EE |
ES |
EC |
ESC |
|
$10 exam/$25 materials co-pay |
$13.80 |
$27.70 |
$29.60 |
$47.30 |
$25 co-pay |
$14.30 |
$28.50 |
$30.40 |
$48.50 |
|
$10 co-pay |
$16.30 |
$32.50 |
$34.80 |
$55.60 |
No Co-pay |
$18.10 |
$36.20 |
$38.70 |
$61.80 |
*the waiting period is from your
last date of service.
Other Rate and Fees Information
Eye Examination
A
complete initial vision analysis which includes an appropriate examination of
visual functions, including the prescription of corrective eyewear where
indicated. Each Covered Person is
entitled to a Eye Examination.
Spectacle Lenses and Frame
Lenses: The Member Doctor will order the proper lenses necessary for your visual welfare. The doctor shall verify the accuracy of the finished lenses. Each Covered Person is entitled to new lenses with the frequency as indicated on the cover sheet of their Certificate. VSP also has controlled costs for cosmetic options, and these charges are typically less than usual and customary fees. Please consult your participating doctor about lens options which may be cosmetic in nature and may result in additional costs.
VSP provides a $130 allowance toward a new frame. If you choose a frame valued at more than the plan's allowance, you will receive a 20 percent discount on the amount over your frame allowance.
Contact lenses:
Your VSP plan provides you with the
flexibility to choose contact lenses instead of glasses. You'll receive a
$105 ($120 in Network effective 01-01-2006) allowance that is applied toward both your contact lens exam and your
contact lenses. You plan includes a 15 percent discount off the cost of
your contact lens exam (fitting and evaluation) when obtained from a VSP
doctor. This exam is performed in addition to your routine eye exam.
It is essential to check for eye health risks associated with improper wearing
or fitting of contacts that if left untreated, can affect the overall health of
your eyes.
You will be responsible for any costs exceeding the allowance. Remember,
if you choose contacts, you will not be eligible to receive lenses and a frame
during the same service period.
Value-Added Discounts
In addition to the 15 percent discount you will receive off your contact lens exam, you may also receive a discount on certain brands of contact lenses. Annual supplies of popular contact lenses are available to you at competitive prices. Visit Members & Consumers or ask your VSP doctor for details.
Your plan also provides a 20 percent discount on additional pairs of prescription glasses (lenses and frame) including prescription sunglasses. Simply return to the same VSP doctor who performed your last covered eye exam within 12 months from the date of the exam.
Laser VisionCare Services:
As a Vision Service Plan member, the opportunity to have laser vision correction surgery has arrived for many who are farsighted, nearsighted or who have an astigmatism. Many of you may be considering this new procedure, which uses an excimer laser to improve vision by reshaping the cornea or front surface of the eye. Eligible members and dependents have access to VSP’s Laser VisionCare program. This program includes comprehensive information on laser vision correction, as well as giving you substantial savings on the procedure. What’s more, you enjoy greater peace of mind knowing that your trusted VSP doctor manages your laser vision correction care and your future eyecare needs.
VSP has arranged for members to receive the procedure at a discounted fee, which could add up to hundreds of dollars in savings. The most you will pay is $1,500 per eye for PRK or $1,800 per eye for LASIK.
How does the plan work?
1. Ready to use the plan? Call VSP at (800) 877-7195 or visit them at VSP.com to get a list of participating providers. VSP Doctor Search
2. Call the participating provider and give them your VSP member ID.
3. Go to your appointment and pay your co-payment. The participating doctor will take care of all the necessary clearances and claim forms.
What if I dont use a Participating Doctor?
More than 90% of VSP patients receive services from participating doctors, although you may select any licensed vision care provider for services. Your reimbursement schedule does not guarantee full payment, nor can VSP guarantee patient satisfaction, when services are obtained from a non-participating provider. Charges submitted to VSP for reimbursement by a non-participating provider will be reimbursed on the basis of prevailing fees, but not to exceed the following schedule of allowances subject to the selected deductible.
| Professional Fees, Visual Examination up to: | $ 45.00 |
| Materials: Single Vision lenses up to: | $ 45.00 |
| Bifocal Lenses up to: | $ 65.00 |
| Trifocal Lenses up to: | $ 85.00 |
| Lenticular Lenses up to: | $125.00 |
| Frame | $ 47.00 |
| Contact Lenses (in lieu of all other materials, materials, fittings and evaluation only) | |
| Necessary, up to: | $210.00 |
| Elective, up to | $105.00 |
V.S.P. Vision, Limitations
Options - This plan is designed to cover your visual needs rather than cosmetic materials. If you select any of the following, you will be responsible for an additional charge: Blended lenses; Contact lenses(except as noted elsewhere herein; Oversize lenses; Progressive multifocal lenses; Photochromatic or tinted lenses other than, Pink 1 or 2; Coated or laminated lenses; A frame that exceeds the plan allowance; certain limitations on low vision care; cosmetic lenses; Optional cosmetic processes; UV protected lenses.
Not Covered -The following professional services or materials are not covered. Discounts may apply to some items: Orthoptics or vision training and any associated supplemental testing; Plano lenses (non-prescription); Two pair of glasses in lieu of bifocals; Lenses and frames furnished under this program which are lost or broken will not be replaced except at the normal intervals when services are otherwise available; Medical or surgical treatment of the eyes; Any eye examination, or any corrective eyewear, required by an employer as a condition of employment; Corrective vision services, treatments, and materials of an experimental nature.
This brochure constitutes only a summary of the Plans. The Plan Contract must be consulted to determine the exact terms and conditions of coverage.
