If you use an in-network provider (including national retail providers like Walmart, Sam's Club, Costco, and Pearle Vision as well as Vision Works), you pay less for services, and you don't need to file a claim form. If you use an out-of-network provider, you receive a lower level of coverage, and you must pay the provider directly and then submit a claim form with your receipts to VSP. The plan reimburses you up to the allowable expense for each covered service.
You'll also save on contacts, glasses, and subglasses when you use your benefits on eyeconic.com®, the VSP preferred online retailer.
VSP does not issue ID cards but you can create an account at www.vsp.com/create-account to download or print an ID card. The customer service number for help is 1-800-877-7195.
Keep in mind that your vision election can be different than your medical or dental election. A comprehensive vision exam is covered through the Medical plan for those without a need for eyeglasses or contact lenses. Medical issues with your eyes are covered under the medical plan and you do not need to elect the Vision plan to have coverage for medical concerns involving your eyes or vision. This includes for those with diabetes.
The table below shows in-network and out-of-network coverage levels. Consult the Vision Plan rate sheet (page 2) to view how much you will pay for coverage.
| In-Network | Out-of-Network | Frequency | |
|---|---|---|---|
| Eye exams | In-Network $10 copay | Out-of-Network Plan reimburses up to $35 | Frequency Once per calendar year |
| Frames | In-Network $150 maximum allowance | Out-of-Network Plan reimburses up to $60 | Frequency One pair of eyeglasses (frames and lenses) or contact lenses once per calendar year |
| , In-Network, Out-of-Network, Frequency Lenses | |||
| Single | In-Network $20 copay | Out-of-Network Plan reimburses up to $25 | Frequency One pair of eyeglasses (frames and lenses) or contact lenses once per calendar year |
| Bifocal | In-Network $20 copay | Out-of-Network Plan reimburses up to $40 | Frequency One pair of eyeglasses (frames and lenses) or contact lenses once per calendar year |
| Trifocal | In-Network $20 copay | Out-of-Network Plan reimburses up to $55 | Frequency One pair of eyeglasses (frames and lenses) or contact lenses once per calendar year |
| Lenticular | In-Network $20 | Out-of-Network Plan reimburses up to $55 | Frequency One pair of eyeglasses (frames and lenses) or contact lenses once per calendar year |
| , In-Network, Out-of-Network, Frequency Contact Lenses | |||
| Conventional, disposable | In-Network $150 maximum allowance | Out-of-Network Plan reimburses up to $110 | Frequency One pair of eyeglasses (frames and lenses) or contact lenses once per calendar year |
| Medically necessary | In-Network Covered in full with prior approval | Out-of-Network Plan reimburses up to $200 | Frequency One pair of eyeglasses (frames and lenses) or contact lenses once per calendar year |
