2020 Ensign Benefits Guide

17 Vision Quality eye care benefits are offered through the Vision Service Plan (VSP). Benefits are designed to help reduce the cost of eyeglasses, contact lenses and other vision services. You can use any vision care provider, but will save money when you use a VSP Choice network provider. With VSP providers, you will typically have 100% of expenses paid by VSP after a copayment, up to the maximum allowable benefit for covered services. If you receive services from an out-of-network provider, you are responsible for paying the provider in full and submitting a claim to VSP for reimbursement. Discounts are available for LASIK surgery, non-prescription sunglasses, contact lens solutions, and other eye care accessories. Note that you can use your benefits at certain specialty optical boutiques or retail chains (such as Costco) through VSP’s affiliate provider network. Affiliate providers can check eligibility and submit claims with VSP. Plan Feature VSP Network Provider Out-of-Network Provider Exam for Eyeglasses Once every 12 months $10 copay $10 copay, Plan pays up to $73 Lenses Once every 12 months • Single vision • Lined Bifocal • Lined Trifocal Lens Options • Standard progressive lenses • Premium progressive lenses • Custom progressive lenses $25 materials copay Copay up to $55 Copay of $95 - $105 Copay of $150 - $175 $25 materials copay Plan pays up to $33 Plan pays up to $50 Plan pays up to $65 Plan pays up to $65 Plan pays up to $65 Plan pays up to $65 Frames Once every 24 months Plan pays up to $130 ($70 for Costco) Plan pays up to $70 Contact Lenses Instead of eyeglasses once every 12 months $130 allowance for contacts Up to $60 copay for contact lens exam (filling and evaluation) Plan pays up to $115 2020 Vision Plan At-a-Glance For more information on covered benefits or to find a VSP provider, go to www.vsp.com or call VSP at 800.877.7195. Finding a VSP provider You should always call a doctor to confirm participation in the VSP network. To find a VSP provider: • Go to the VSP website at www.vsp.com . • Find the “ Members & Consumers ” section. • Follow the directions to register as a site user, or fill in your User ID and password. • Select the “ Find a VSP Doctor ” tab.