| Plan Details | ||
|---|---|---|
| Plan Name | VSP Buy-Up Plan | |
| Effective Dates | Jan 01, 2022 to Dec 31, 2025 | |
| Benefits | In-Network | Out-of-Network |
| Exam Copay | $10 | Up to $40 allowance |
| Materials Copay | $0 | Based on fee schedule |
| Exam Frequency | Every calendar year | Every calendar year |
| Lenses Frequency | Every calendar year | Every calendar year |
| Frames Frequency | Every calendar year | Every calendar year |
| Contacts Frequency | Every calendar year | Every calendar year |
| Single Vision Lens | $0 | Up to $30 allowance |
| Medically Necessary Contacts | Covered in full | Not Covered |
| Elective Contacts | $130 allowance for contacts; copay does not apply | Up to $130 allowance |
| Frames | $150 frame allowance after $10 Copay | Up to $60 allowance |
| Corrective Vision Services (e.g. Laser Surgery) | Discount available | Not Covered |
| Second Pair of Glasses | Discount available | Not Covered |