| Plan Details | ||
|---|---|---|
| Plan Name | VSP Signature | |
| Effective Dates | Jul 01, 2023 to Jan 01, 2025 | |
| Benefits | In-Network | Out-of-Network |
| Exam Copay | $20 | $50 reimbursed |
| Materials Copay | $0 | Based on fee schedule |
| Exam Frequency | 12 months | 12 months |
| Lenses Frequency | 12 months | 12 months |
| Frames Frequency | 24 months | 24 months |
| Contacts Frequency | 12 months | 12 months |
| Single Vision Lens | $0 | $50 reimbursed |
| Medically Necessary Contacts | N/A | N/A |
| Elective Contacts | $175 | $105 reimbursed |
| Frames | $175 for Frame; $195 for Featured Frame Brands; $95 for Walmart/Sam's Club/Costco frame | $70 reimbursed |
| Corrective Vision Services (e.g. Laser Surgery) | Discount available | Not covered |
| Second Pair of Glasses | Discount available | Not covered |