Download a PDF of the Plan Summary to the right.
| In-network Provider | Out-of-network Provider | |
|---|---|---|
|
Routine Eye Exam Every calendar year |
$10 copay | $50 allowance |
|
Frames Every other calendar year; if lenses and frames are purchased together, the combined copay is $25 |
$25 copay $230 frame allowance; 20% savings on the amount over your allowance |
$70 allowance per two years |
|
Standard Lenses Single vision, lined bifocal, lined trifocal; polycarbonate Every calendar year |
$25 copay | Single: $50 Bifocal: $75 Trifocal: $100 (allowance per year) |
|
Contacts - Medically Necessary Every calendar year |
$25 copay | $300 allowance per year |
|
Contacts - Cosmetic Every calendar year |
$180 allowance per year applied to contact lenses and contact lens exam (fitting and evaluation) | $120 allowance per year |
| Discounts: Visit VSP.com to learn about discounts on laser vision correction and soft contact lenses. | ||