Vision
Healthy eyes and clear vision are an important part of your overall health and quality of life. You may enroll yourself and your eligible dependents or you may waive vision coverage. You do not have to be enrolled in medical coverage to elect vision coverage or cover the same dependents under medical and vision.
Although vision care services and supplies are covered in-network and out-of-network, your benefits are generally greater when you use in-network providers. Your costs are based on the family members you choose to cover.
VSP Vision Base
Plan Information
Plan Name: VSP Vision Base
Policy Number: 30029447
Effective Date: 01/01/2025
Network: VSP
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
In-Network
Exams
$10 copay
Single Vision Lenses
$0 after applicable copay
Bifocal Lenses
$0 after applicable copay
Trifocal Lenses
$0 after applicable copay
Frames
$130 maximum ($70 for Costco)
Contacts (in lieu of glasses)
$130 maximum
Frequency
Exams
Once every 12 months
Lenses
Once every 12 months
Frames
Once every 24 months
Contacts
Once every 12 months
Out-of-Network Reimbursement
Exams
$10 copay (Up to $50 reimbursement)
Single Vision Lenses
Up to $50 reimbursement
Bifocal Lenses
Up to $75 reimbursement
Trifocal Lenses
Up to $100 reimbursement
Frames
Up to $70 reimbursement after applicable copay
Contacts (in lieu of glasses)
Up to $105 reimbursement
Frequency
Exams
Once every 12 months
Lenses
Once every 12 months
Frames
Once every 24 months
Contacts
Once every 12 months
Plan Documents
Contact Information
VSP Vision Buy-Up
Plan Information
Plan Name: VSP Vision Buy-Up
Policy Number: 30029447
Effective Date: 01/01/2025
Network: VSP
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
In-Network
Exams
$10 copay
Single Vision Lenses
$0 after applicable copay
Bifocal Lenses
$0 after applicable copay
Trifocal Lenses
$0 after applicable copay
Frames
$180 maximum ($100 for Costco)
Contacts (in lieu of glasses)
$180 maximum
Frequency
Exams
Once every 12 months
Lenses
Once every 12 months
Frames
Once every 12 months
Contacts
Once every 12 months
Out-of-Network Reimbursement
Exams
$10 copay
Single Vision Lenses
Up to $50 reimbursement
Bifocal Lenses
Up to $75 reimbursement
Trifocal Lenses
Up to $100 reimbursement
Frames
Up to $70 reimbursement after applicable copay
Contacts (in lieu of glasses)
Up to $105 reimbursement
Frequency
Exams
Once every 12 months
Lenses
Once every 12 months
Frames
Once every 12 months
Contacts
Once every 12 months