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Information to Review
2021 Premium Rates
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Other Items to Consider
VSP uses a network of participating providers.
VSP pays for the majority of expenses for a number of services when you use a participating provider.
VSP also covers laser vision correction surgery at a discounted fee when you use a participating provider.
You will not need to file a claim for benefits. Your VSP provider will work directly with VSP.
When searching for a participating provider, search the VSP Signature network
If you use a non-participating provider, VSP provides a service allowance for most covered services.
vsp.com for more details on your vision beneﬁt and for exclusive savings and promotions for VSP members.
Focuses on your eyes and overall wellness
Every calendar year
See frame and lenses
$180 allowance for a wide selection of frames$200 allowance for featured frame brands20% savings on the amount over your allowance$100 Costco allowance
Included in Prescription Glasses
Adults: Every other calendar year
Children: Every calendar year
Single vision, lined bifocal, and lined trifocal lensesPolycarbonate lenses for dependent children
Included in Prescription Glasses
Standard progressive lensesPremium progressive lensesCustom progressive lensesAverage savings of 35-40% off other lens enhancements
$50$80 - $90$120 - $160
Contacts(instead of glasses)
$180 allowance for contacts and contact lens exam (fitting and evaluation)15% savings on a contact lens exam (fitting and evaluation)
Diabetic Eyecare Plus
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.
Glasses and Sunglasses
Extra $20 to spend on featured frame brands. Go to
vsp.com/specialoffers for details.
30% savings on additional glasses and sunglasses, including lens enhancements, from the same VSP provider on the same day as your WellVision Exam. Or get 20% from any VSP provider within 12 months of your last WellVision Exam.
No more than a $39 copay on routine retinal screening as an enhancement to a WellVision Exam
Laser Vision Correction
Average 15% off the regular price or 5% off the promotional price; discounts only available from contracted facilities
After surgery, use your frame allowance (if eligible) for sunglasses from any VSP doctor.
$12.18 Employee only$19.12 Employee + spouse$21.04 Employee + child(ren)$33.95 Employee + family
*Coverage with a participating retail chain 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.
vsp.com for details, if you plan to see a provider other than a VSP doctor.
Exam .........up to $50Frame ....... up to $70
Contacts ....up to $105
Single Vision Lenses ......up to $50Lined Bifocal Lenses ......up to $75
Lined Trifocal Lenses .....up to $100 Progressive Lenses ........up to $75
When visiting a non-participating provider, copays will still apply. The maximum allowance for Out-of-Network Providers is listed in the benefit summary above. If visiting Walmart or Sam’s Club locations, request an Assignment of Benefits (AOB) to have the copay deducted from the cost of your visit.
Participants will need to pay the entire bill at the time of service and submit a claim for reimbursement to VSP.
Out-of-network claims must be submitted to VSP within one year from the date of service.