Vision

Healthy eyes and clear vision are an important part of your overall health and quality of life. You may enroll yourself and your eligible dependents or you may waive vision coverage. You do not have to be enrolled in medical coverage to elect vision coverage or cover the same dependents under medical and vision.

Although vision care services and supplies are covered in-network and out-of-network, your benefits are generally greater when you use in-network providers. Your costs are based on the family members you choose to cover.

VSP Select Plan

Plan Information

Plan Name: VSP Select

Policy Number: 00112854

Effective Date: 01/01/2025

Network: VSP Choice

In-Network Benefit Highlights

Deductible (Individual/Family)
$XX/$XX

Out-of-Pocket Max (Individual/Family)
$XX/$XX

Preventive Care
$XX

Primary Care Visit
$XX

Specialist Visit
$XX

Urgent Care
$XX

Emergency Room
$XX

Benefit Highlights

In-Network Only

Exams
$10 copay

Materials
$20 copay

Single Vision Lenses
Included in materials copay

Bifocal Lenses
Included in materials copay

Trifocal Lenses
Included in materials copay

Frames
$120 maximum allowance
$65 allowance for Costco frames
20% off over your allowance

Contacts (in lieu of glasses)
No copay; $120 allowance

Frequency

Exams
Once every 12 months

Lenses
Once every 24 months

Frames
Once every 24 months

Contacts
Once every 24 months

Plan Documents

2025 VSP Select Benefit Summary

Contact Information

(800) 877-7195

vsp.com

VSP Premium Plan