Your 2021 Benefits Resource

Vision Coverage

Your vision coverage is provided by VSP. Choose from one of two plans to suit the needs of you and your family. For the optimal level of benefits, be sure to visit an optometrist that is within the VSP network. To locate an in-network provider use the “Find a Doctor” feature on the VSP website.

VSP Core Plan VSP Buy-Up Plan Frequency
Vision Exam $10 copay $10 copay Every calendar year
Prescription Glasses $25 copay $10 copay Every calendar year

Frames Benefit

$150 allowance per person ($170 for featured frames)
+20% discount over allowance or $80 allowance at Costco
$200 allowance per person ($220 for featured brands)
+20% discount over allowance or $110 allowance at Costco
Every calendar year
Lenses Benefit Included in Prescription Glasses
Single vision, lined bifocal, and lined trifocal lenses
Polycarbonate lenses for dependent children
Every calendar year
Lens Enhancements $0 – $160 copay, depending on lens type
(standard progressive, premium progressive, custom progressive)
Every calendar year
Contact Lenses (in lieu of glasses) Up to $60 copay (exam and fitting)
$130 allowance for contact lenses
Up to $60 copay (exam and fitting)
$200 allowance for contact lenses
Every calendar year

* Both vision plans provide benefits for prescription glasses or contact lenses once each calendar year. The VSP Buy-Up Plan also provides benefits for
a second pair of prescription glasses or contact lenses each year, subject to the same copays and allowances. For more details, see the Vision Plan Benefit
Summaries on the Resources page.

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Vision Premiums Per Semi-Monthly Pay Period

Core Plan Buy-Up Plan
Employee Only $0.00 $4.30
Employee + Child(ren) $0.50 $6.98
Employee + Spouse/Domestic Partner $0.50 $6.84
Family $0.50 $11.25

No ID cards are issued for the vision plan.

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Out-of-Network Coverage

Both plans also provide limited benefits for out-of-network services. For information on out-of-network benefits call VSP Member Services at 800-877-7195.

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