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 Voluntary Vision (Low)
Plan Information
Plan Name: VSP Voluntary Vision (Low)
Policy Number: 30017328
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
$20 copay
Single Vision Lenses
$20 copay
Bifocal Lenses
$20 copay
Trifocal Lenses
$20 copay
Frames
Coverage limited to $130; $150 for featured brands
Contacts (in lieu of glasses)
Coverage limited to $130
Frequency
Exams: Once every 12 months
Lenses: Once every 12 months
Frames: Once every 24 months
Contacts: Once every 12 months
Out-of-Network
Exams
Up to $50 reimbursement after $20 copay
Single Vision Lenses
Up to $50 reimbursement after $20 copay
Bifocal Lenses
Up to $75 reimbursement after $20 copay
Trifocal Lenses
Up to $100 reimbursement after $20 copay
Frames
Up to $70 reimbursement after $20 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
Year Carrier Document Name
Contact Information
VSP Voluntary Vision (High)
Plan Information
Plan Name: VSP Voluntary Vision (High)
Policy Number: 30017328
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
$20 copay
Single Vision Lenses
$20 copay
Bifocal Lenses
$20 copay
Trifocal Lenses
$20 copay–
Frames
Coverage limited to $200; $220 for featured brands
Contacts (in lieu of glasses)
Coverage limited to $200
Frequency
Exams: Once every 12 months
Lenses: Once every 12 months
Frames: Once every 12 months
Contacts: Once every 12 months
Out-of-Network
Exams
Up to $50 reimbursement after $20 copay
Single Vision Lenses
Up to $50 reimbursement after $20 copay
Bifocal Lenses
Up to $75 reimbursement after $20 copay
Trifocal Lenses
Up to $100 reimbursement after $20 copay
Frames
Up to $70 reimbursement after $20 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
Plan Documents
Year Carrier Document Name