2014-2015 School Year
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Member Services Phone Number: 1-800-877-7195 

Summary of Vision Plan Benefits


$10.00 copay every plan year1

WellVision Exam® focuses on your eye health and overall wellness every 12 months
Prescription Glasses
Lenses every 24 months
  • Single vision, lined bifocal, lined trifocal lenses.
  • Polycarbonate lenses for dependent children.
Frame every 24 months
  • $120 allowance for frame of your choice
  • 20% off the amount over your allowance
Contact Lenses
Contact Lens Care every 24 months
No copay applies every 24 months
  • $120 allowance for contacts and the contact lens exam (fitting and evaluation). This additional exam ensures proper fit of contacts.
  • Current soft contact lens wearers may qualify for a special program that includes a contact lens evaluation and initial supply of replacement lenses.

Extra Discounts and Savings

Glasses and Sunglasses

  • Average 30% savings on lens options like progressives and scratch-resistant and anti-reflective coatings
  • 20% off additional glasses and sunglasses, including lens options*


  • 15% off cost of contact lens exam (fitting and evaluation)

Laser Vision Correction

  • Average 15% off the regular price or 5% off the promotional price from contracted facilities
  • After surgery, use your frame allowance (if eligible) for sunglasses from any VSP doctor

* Available from any VSP doctor within 12 months of your last eye exam

You get the best value from your benefit when you see a VSP doctor. If you see a non-VSP provider, you’ll typically pay more out-of-pocket. You’ll pay the provider in full and have 6 months to submit a claim to VSP for partial reimbursement less copays. Before seeing a non-VSP provider, call us at (800) 877-7195.

Out-of-Network Reimbursement Amounts:

Exam Up to $40.00
Single vision lenses Up to $30.00
Lined bifocal lenses Up to $45.00
Lined trifocal lenses Up to $60.00
Frame Up to $45.00
Contacts Up to $100.00

VSP guarantees service from VSP doctors only. In the event of a conflict between this information and your organization's contract with VSP, the terms of the contract will prevail.

1every 12 months

Vision Therapy Benefit

Vision Therapy offers treatment for members having severe visual problems associated with sensory and/or muscular deficiencies of the visual system.

While the number of people needing Vision Therapy is low, it is an extremely important benefit to those who need it, and relatively expensive when no benefit coverage is available. Private-pay patients needing vision therapy often face high costs because of the amount of time the doctor must spend in diagnosing the case, deciding on appropriate treatment and training the patient to coordinate his or her visual functions.


Members who have visual problems diagnosed by a VSP doctor are entitled to professional services from the doctor, as well as eyewear or other aids prescribed by the doctor as described in Plan Limitations below. When a VSP doctor determines the presence of the visual problems, the doctor requests advance approval before beginning services. Services and eyewear covered can include supplemental testing, evaluations and training.

Plan Limitations

The following are limitations under this Vision Therapy benefit:

Prior Authorization- When a need for Vision Therapy is suspected, the VSP doctor will request a review by our Vision Therapy consultants. Following the review, the consultants may authorize supplemental testing by the doctor. This testing is covered by the plan with no copay. The purpose of the testing is to determine the nature of the problem and to allow the doctor to gather enough information to propose a treatment plan.

Copay- After supplemental testing, the doctor submits a treatment plan to VSP for review. Upon approval, VSP will authorize benefits on a copay basis. VSP covers 75 percent of the treatment. The remaining 25 percent is the member’s responsibility.

Benefit Maximum- The total maximum annual benefit available to any covered person under a Vision Therapy plan is $750, excluding copay, with the member paying 25 percent and VSP paying 75 percent. In addition, if supplemental testing is approved, VSP will pay up to $85 annually.

Plan Exclusions

Perceptual training for a learning disability is not covered under this plan.

Out-of-Network Providers

Vision Therapy benefits secured from a doctor who is not a VSP doctor are subject to the same time limits and copay arrangements described herein. Members should pay the out-of-network provider the full fee. Members will be reimbursed in accordance with an amount not to exceed what VSP would pay a provider in similar circumstances.

NOTE: There is no assurance that this amount will be within the 25 percent copay feature. Reimbursement benefits are not assignable.

Please contact your VSP representative for more information.

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