BENEFITS
PORTAL
PORTAL
Eye Exams
Covered in Full (after $10 Deductible)
Lenses
Single Vision, Bi-Focal, Trifocal Covered in
Full (after a $25 deductible)
Full (after a $25 deductible)
Frames
Medically Necessary Covered in Full
An Allowance of $120 for Elective Contacts
An Allowance of $120 for Elective Contacts
In Network Benefits
Vision Benefits
Eye Exams
$35)
Lenses
$25 Single/$45 Bi Focal/$55 Tri Focal
Frames
$45. Elective Contacts $105
Out of Network Network Benefits
Your benefits are provided by VSP.
Frequency of Coverage
Eye Exams Every 12 months
Lenses Every 12 months
Frames Every 12 months
Eye Exams Every 12 months
Lenses Every 12 months
Frames Every 12 months
Membership : 1-800-888-2435
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