Low Plan
designed for participants who expect to need only basic services
With the Vision Service Plan (VSP), you save money on eye exams, eyeglasses, lenses, contact lenses and more. VSP covers annual exams and corrective treatment to help you keep your vision strong and eyes healthy. If you choose not to enroll in this coverage, consider setting aside money in the Healthcare Flexible Spending Account (FSA) or Health Savings Account (HSA)—if enrolled—to cover vision expenses you might have during the year.
Most providers accept VSP, but we recommend checking the VSP website to confirm or find an in-network doctor. VSP does not provide ID cards, so your provider will verify your coverage by your SSN. Your VSP group number is 12227971.
Your vision plan options are
High Plan
designed for participants who expect to need more comprehensive services
Key features at a glance
Flexible designs
that provides you with choices and benefits.
Affordable coverage
that helps you manage the cost of vision care.
Wide network of providers
that have agreed to negotiated rates, which helps you save money.
In-network cost savings
You pay less when you use a VSP in-network doctor. Save on eyewear and eye care when you see a VSP network doctor. Plus, take advantage of Exclusive Member Extras for additional savings. VSP providers will also take care of all the paperwork for you, saving you the hassle of filing claim forms and waiting for reimbursements when you receive services from out-of-network providers.
Below is a snapshot of vision coverage, and you can find the full coverage listed in the Vision Summary Plan Description found in the Documents section on this page. The Vision Plan covers one eye exam every calendar year and one pair of eyeglasses (or contact lenses) every calendar year for you and each covered dependent, after the applicable copay. As a best practice, we recommend confirming your applicable copay before getting service.
In-network
| Low Plan | High Plan | |
|---|---|---|
| Annual deductible | None | None |
| Eye exam (once every calendar year) | 100% covered after $15 copay | 100% covered after $10 copay |
| Frames (one per calendar year) | $120 allowance after $25 copay; or $70 allowance at Walmart, Sam’s Club and Costco Optical | $120 allowance after $10 copay; or $110 allowance at Walmart, Sam’s club and Costco Optical |
| Lenses (single, bifocal lined or trifocal lined; one per calendar year) | 100% covered after $25 copay | 100% covered after $10 copay |
| Lens options | ||
| UV coating | 100% covered | 100% covered |
| Tint (solid and gradient)/Light-reactive lenses | 100% covered | 100% covered |
| Scratch resistant | 100% covered | 100% covered |
| Polycarbonate | 100% covered | 100% covered |
| Anti-reflective coating | 100% covered | 100% covered |
| Standard Progressive lenses | 100% covered | 100% covered |
| Contact lenses (in lieu of lenses and frames; one per calendar year) | ||
| Medically necessary | 100% covered after $25 copay | 100% covered after $10 copay |
| Elective lenses and contact lens exam (fitting and evaluation) | $125 allowance | $200 allowance |
| Other services | In-network discounts available | |
| Diabetic EyeCare Plus Program | $20 copay for additional exams and services. Retinal screening covered in full for members with diabetes. | |
Out-of-network (copays apply to out-of-network billed amounts)
| Low Plan | High Plan | |
|---|---|---|
| Annual deductible | None | None |
| Eye exam | $50 allowance | $50 allowance |
| Frames | $70 allowance | $70 allowance |
| Lenses | ||
| Single | $50 allowance | $50 allowance |
| Bifocal lined / Progressives | $75 allowance | $75 allowance |
| Trifocal lined | $100 allowance | $100 allowance |
| Lenticular | $125 allowance | $125 allowance |
| Lens options | ||
| UV coating | Not covered | Not covered |
| Tint (solid and gradient) | $5 allowance | $5 allowance |
| Scratch resistant | Not covered | Not covered |
| Basic polycarbonate | Not covered | Not covered |
| Standard anti-reflective | Not covered | Not covered |
| Contact lenses (in lieu of lenses and frames) | ||
| Medically necessary | $210 allowance | $210 allowance |
| Elective | $125 allowance | $125 allowance |
| Other services | N/A | |
Services not covered
Benefits are paid for most vision services and appliances; however, some limits and exclusions do apply. Below is an overview of services not covered, and you can review the Vision Summary Plan Description found in the Documents section on this page for more details:
- Eye exams as a condition of employment, medical or surgical treatment (may be covered under Medical Plan)
- Nonprescription lenses
- Prescription goggles
- Safety eyewear
- Replacement and repair of lost or broken lenses
- Vision training
- Services covered by Workers’ Compensation
- Two pairs of glasses instead of bifocals
Here’s how to make the most of your vision benefits
Use VSP providers.
When you use a VSP network doctor for an eye exam or to purchase eyeglasses, you pay less than if you go outside the network. In addition, VSP doctors take care of all of your paperwork; there are no claims to file. If you don’t use a VSP doctor, you’ll receive an allowance toward your incurred expenses. You’ll pay for expenses when you receive them, then submit a claim for plan reimbursement.
File all claims promptly.
If you use an out-of-network provider, you must file your claim within six months of the date of service.
Use VSP discounts.
Visit VSP for a list of available discounts.
Eyeconic — the VSP online eyewear store
Prefer to shop online? Use your vision benefits on eyeconic.com® — the VSP preferred online retailer. With the widest selection of quality eyewear, you’re sure to find the eyewear you love at a price that’s right for you. Shop online at Eyeconic and choose from the most popular brands of designer eyewear and contact lenses, at competitive prices. All VSP members receive a 20% discount on prescription and non-prescription eyewear purchased through the online store.
What’s more, as a VSP member, you’ll enjoy the highest savings available when you use your in-network VSP insurance for prescription glasses or contact lenses.
Diabetic EyeCare Plus program
If you have diabetic eye disease, glaucoma, or age-related macular degeneration (AMD), you can receive routine care and follow-up medical eye services at your VSP doctor for a $20 copay. If you have diabetes but do not show signs of diabetic eye disease, you can also receive preventive retinal screenings at no cost to you.
To get started, find a VSP doctor by calling 1-800-877-7195 or visiting VSP. No VSP ID card is needed — simply inform your doctor’s office that you have VSP coverage.
Member and website support
For a listing of in-network providers in your area, call toll-free 1-800-877-7195 or visit VSP. Your VSP group number is 12227971.