Vision Service Plan (VSP) features more than 22,000 professional vision care providers for persons covered under the Relief PPO Medical Plan. Using your VSP benefits is easy. Find a provider who is right for you, renew your benefit information and at your appointment, tell your provider you have VSP. That’s it! There are no I.D. cards or claim forms necessary.
PLAN SUMMARY
| VSP | NON-VSP | |
|---|---|---|
 EYE EXAM *Once per calendar year | $10 COPAY | Up to $45 |
| VSP | NON-VSP | |
|---|---|---|
 LENSES *Once per calendar year | 100% | Up to $45 Single Vision Up to $65 Bifocal Up to $85 Trifocal |
| VSP | NON-VSP | |
|---|---|---|
 FRAMES *Once per calendar year | Up to $200 | Up To $47 |
| VSP | NON-VSP | |
|---|---|---|
 CONTACT LENSES (Instead of Glasses) *Once per calendar year | Up to $160 | Up to $105 |
| VSP | NON-VSP | |
|---|---|---|
LASIK SURGERY *Once per lifetime | Plan pays up to $1500 per eye | No Coverage |
Vision coverage is automatically included when you enroll in the Relief PPO Medical Plan. You can choose any provider, but you’ll save money if you use a VSP network provider. If you use a non-VSP provider, you are responsible for paying the provider in full and submitting a claim to VSP for reimbursement. Take a look at the Benefits Summary for your vision benefits through VSP.
To find a vision care provider or for more information, call VSP at (800) 877-7195 or visit vsp.com.
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