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.
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.
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.
|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.
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:
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.