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Benefits Summary - SDRMA - 2015-01-01Get the best in eyecare and eyewear with CSAC EIA / S mall Group and VSP ® Vision Care. At VSP, we invest in the things you value most—the best care at the lowest out-of-pocket costs. Because we’re the only national not-for-profit vision care company, you can trust that we’ll always put your wellness over profit. • Value and Savings. You’ll enjoy more value and the lowest out-of-pocket costs. • High Quality Vision Care. You’ll get the best care from a VSP doctor including a WellVision Exam ®—the most comprehensive exam designed to detect eye and health conditions. • Choice of Providers. The decision is yours to make—choose a VSP doctor, retail chain affiliate, or any other provider. • Great Eyewear. It’s easy to find the perfect frame at a price that fits your budget. You’ll like what yo u see with VSP.Using your VSP benefit is easy. • Find an eyecare provider who’s right for you. To find a VSP doctor or retail chain affiliate, visit vsp.com or call 800.877.7195 . • Review your benefit information. Once your benefit is effective, visit vsp.com to review your plan coverage before your appointment. • At your appointment, tell them you have VSP. There’s no ID card necessary. That’s it! We’ll handle the rest —there are no claim forms to complete when you see a VSP doctor or retail chain affiliate. Choice in Eyewear From classic styles to the latest designer frames, you’ll find hundreds of options. Choose from great brands, like bebe ®, ck Calvin Klein, Flexon ®, Lacoste, Michael Kors, Nike, Nine West, and more. Visit vsp.com to find a doctor who carries these brands. See why we’re consumers’ #1 choice in vision care. Contact us. vsp.com | 800.877.7195 ©2010 Vision Service Plan. All rights reserved.VSP and WellVision Exam are registered trademarks of Vision Service Plan. All other company names and brands are trademarks or registered trademarks of their respective owners.See why we’re consumers’ #1 choice in vision care. Contact us. vsp.com | 800.877.7195 Your VSP Vision Benefits Summary CSAC EIA / Small Group and VSP provide you with an affordable eyecare plan. VSP Doctor Network: VSP Signature Visit vsp.com for more details on your vision benefit and for exclusive savings and promotions for VSP members. Copay Description Benefit Frequency Your Coverage with VSP Doctors and Affiliate Providers* WellVision Exam • Focuses on your eyes and overall wellness $25 for exam and glasses Every 12 Months Prescription Glasses Frame • $130 allowance for a wide selection of frames • $150 allowance for featured frame brands like bebe®, ck Calvin Klein, Flexon®, Lacoste, Michael Kors, Nike, Nine West, and more • 20% savings on the amount over your allowance • $70 allowance for Costco frames Combined with exam Every 24 Months Lenses • Single vision, lined bifocal, and lined trifocal lenses • Polycarbonate lenses for dependent children Combined with exam Every 12 Months Lens Enhancements • Standard progressive lenses • Premium progressive lenses • Custom progressive lenses • Average savings of 35-40% on other lens enhancements $50 $80 - $90 $120 - $160 Every 12 Months Contacts (instead of glasses) • $130 allowance for contacts; copay does not apply • Contact lens exam (fitting and evaluation) Up to $60 Every 12 Months Diabetic Eyecare Plus Program • Services related to diabetic eye disease, glaucoma and age-related macular degeneration (AMD). Retinal screening for eligible members with diabetes. Limitations and coordination with medical coverage may apply. Ask your VSP doctor for details. $20 As needed Extra Savings Glasses and Sunglasses • Extra $20 to spend on featured frame brands. Go to vsp.com/specialoffers for details. • 30% savings on additional g lasses and s unglasses, including lens enhancements, from the same VSP doctor on the same day as your WellV ision Exam. Or get 20% from any VSP doctor within 12 months of your last WellVision Exam. Laser Vision Corr ection • A v erage 15% off the regular price or 5% off the promotional price; discounts only available from contracted facilities Visit vsp.com for details, if you plan to see a provider other than a VSP doctor. Exam ..................................................up to $50 Frame ................................................up to $70 Single Vision Lenses .................up to $50 Lined Bifocal Lenses ................up to $75 Lined Trifocal Lenses ...............up to $100 Progressive Lenses ...................up to $75 Contacts ..........................................up to $105 Your Coverage with Other Providers *Coverage with a retail chain affiliate may be different. Once your benefit is effective, visit vsp.com for details. Coverage information is subject to change. In the event of a conflict between this information and your organization’s contract with VSP, the terms of the contract will prevail. Based on applicable laws, benefits may vary by location.