Health Summary Plan Description

Vision Benefits

The Health Plan provides vision benefits through Vision Service Plan (VSP). This benefit is intended for routine vision care. The diagnosis and treatment of eye disease or injury is covered under the medical benefits.

Eligibility

Plan I Earned, Self-Pay and Senior Performer participants and their enrolled dependents are eligible for the Exam Plus Plan. Vision benefits are not provided to Plan II Earned and Self-Pay participants and their enrolled dependents.

How To Locate a VSP Provider

  • You may call (800) 877-7195 and request that a list of VSP participating doctors be mailed to you. Or, you may enter a specific doctor's telephone number to verify the office's participation in the VSP network.
  • You may visit the VSP website at www.vsp.com to locate a participating provider near you.
  • You may contact VSP through the mail at: Vision Service Plan, P.O. Box 997100, Sacramento, CA 95899-7100.

How to Use the Benefit

  1. Locate a VSP Exam Plus doctor.
  2. Call the doctor to make an appointment.
  3. Identify yourself as a VSP Exam Plus participant through the SAG-Producers Health Plan.
  4. Provide the doctor with your ID number. If the patient is a dependent child, you will also need to state the patient's date of birth.

After you make an appointment, your doctor and VSP will handle the rest.

The Exam Plus Plan includes an eye exam every calendar year for Plan I participants and their eligible dependents. Vision exams include an analysis of the patient's visual functions, including prescription of corrective lenses when indicated. The exam includes additional services and follow-up eye care for participants and dependents with type 1 diabetes. The Plan also offers discounts on complete pairs of glasses as well as professional services associated with prescription contact lenses. These discounts are off the doctor's usual and customary charge.

Vision Benefits
Exam Plus Plan Eye Exams Glasses Professional Services for Contact Lenses
Network $10 copay; one exam per calendar year 20% discount 15% discount
Non-Network 80% of doctor's customary charge up to a maximum payment of $50*; one exam per calendar year No benefit No benefit

* If the eye exam is received through a non-VSP provider, pay the full amount of the bill and submit a claim for reimbursement as described on page 86.

Discounts on frames, lenses and professional fees for contact lenses are only guaranteed when you purchase them within 12 months of the last covered eye exam from any VSP network provider. For glasses, you must purchase both lenses and frames. Contact lenses are available at the VSP doctor's normal retail price.


Laser Vision Correction Surgery

The Exam Plus Plan provides a discount on three commonly performed laser vision correction procedures – laser-assisted in-situ keratomileusis (LASIK), Custom LASIK and photorefractive keratectomy (PRK). Although the Health Plan does not pay the cost of the surgery, you have access to the procedures at reduced fees through VSP's network of doctors and
laser centers. You will pay the provider's discounted rate which will not exceed the following:

  • $1,500 per eye for PRK;
  • $1,800 per eye for LASIK; or
  • $2,300 per eye for Custom LASIK.

The fee includes both pre and post-operative care through your VSP doctor.

To schedule a complimentary screening and consultation on the benefits and risks of laser vision correction, call your VSP doctor. Participating doctors can also be located on VSP's website at www.vsp.com or by calling toll-free, (800) 877-7195.