Your Vision Benefits at a Glance


Vision Plan
Covered Expenses	If you see a VSP provider, you pay a $10 copay and the plan pays the amount listed below	If you see a non-VSP provider, you pay the bill in full and the plan reimburses you the amounts listed below, minus a $10 copay
Exam (once every 12 months)	100%	Up to $40
Eyeglass lenses (one pair every 12 months)
Single vision	100%	Up to $40
Lined bifocal	100%	Up to $60
Lined trifocal	100%	Up to $80
Progressive lenses	100%	Up to trifocal allowance of $80
Lenticular	100%	Up to $125
Polycarbonate lenses for children	100%	Not covered
Anti-reflective coating	100%	Not covered
Color/mirror coating	100%	Not covered
Scratch coating	100%	Not covered
Tints/photochromic lenses	100%	Up to $5
UV lenses	100%	Not covered
Eyeglass frames (once every 24 months)	Up to $130; if you choose a frame that costs more than the VSP allowable amount, you'll receive 20% off your out-of-pocket cost	Up to $45
Contact lenses (once every 12 months in place of eyeglass lenses and frames)
Elective (Providers may bill you for contact lenses separately or they may include the lenses, fittings and follow-up fees in a single bill; all contact lens fees apply to the $105 maximum paid by the plan)	Up to $105	Up to $105
Medically necessary (See "Knowing What's Covered and What's Not.")	100% (Preauthorization required)	Up to $210 (Preauthorization required)
Low-vision benefit	75% up to $1,000 (Preauthorization required)	75% up to $1,000 (Preauthorization required)

VSP providers generally require two to three working days to make lenses, based on the lab and eyewear selected. If you don't have a back-up pair of glasses and would like a faster turnaround, your provider may be able to accommodate you, depending on its arrangements with the lab. Because the cost and arrangements vary by provider, contact your VSP provider for details.