Under the Vision Plan, you and your eligible dependents may each receive, subject to the payment provisions and frequency guidelines outlined in the chart below, the following:
- - A comprehensive eye exam, including a refraction test to determine the need for glasses, binocularity analysis and testing the overall health of the eyes and related optic structures.
- - Additional testing for glaucoma and depth perception.
- - Necessary prescription lenses and frame, or contacts in lieu of lenses and a frame. (If you obtain contact lenses, you will be eligible for new lenses after 12 months and a new frame after 24 months.)
Vision Plan at a Glance
| Type of Expense | Frequency Allowance | When You Use Network Providers … | When You Use Out-of-Network Providers, the Plan Pays up to … |
| Exam | Every 12 months | $15 copay, then the plan pays 100% | $43 |
| Corrective lenses [1] | Every 12 months | $15 copay, then the plan pays 100% | $40-single lenses$60-lined bifocals$73-lined trifocals$80-lenticular lenses |
| Frames | Every 24 months | $15 copay, then the plan pays up to $120 [2] | $47 |
| Contacts (includes exam, contact lenses and fitting) | Every 12 months in lieu of lenses and frame | ||
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$15 copay, then the plan pays 100% | $210 | |
|
Covered up to $150 | $150 | |
| Laser vision correction surgery | VSP and OptumHealth Vision have contracted with many laser surgery facilities and doctors to offer you access to laser vision correction surgery for much less than what you might pay privately. For more information, see the VSP/OptumHealth Vision Web sites. | ||
| Additional benefits | The following discounts are available when you use network providers:
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Elective vs. Medically Necessary Contact Lenses
When buying elective contact lenses, you receive a $150 allowance toward the total cost of the lenses, which includes evaluation exams, fitting costs and materials. You are reimbursed the same amount whether you go to a participating or non-participating doctor. If you buy your prescription contacts from a participating doctor, charges for professional services may be discounted. You pay the difference between the total cost of the contact lenses (including exams and fitting costs) and the allowance.
Elective contact lenses are those that are not medically necessary. Medically necessary contact lenses are only those prescribed for any of the following:
- Following cataract surgery,
- To correct extreme problems that cannot be corrected by eyeglasses, or
- Due to anisometropia (a significant difference in vision between the two eyes) or keratoconus (a disease of the cornea).
[1] If you purchase lenses and frames at the same time, only one $15 copay applies.
[2] If you select a frame that is not paid in full by the vision plan, you pay the difference between the retail allowance the claims administrator provides and the claims administrator’s discounted retail cost of the frame.
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Questions about your employee benefits or other Human Resources issues? Contact the Workplace Solutions Center at (888) 471-2271.