Vision Coverage

The following chart summarizes the Vision benefits for the Vision plan offered to all eligible employees.

Vision Plan VSP Signature Network

Benefit	In-Network	Out-of-Network
Copays	Eye Exam: $10 Copay Materials: $10 Copay
	Coverage after Copay(s):	Out-of-Network Reimbursement
Basic Eye Exam	100% Coverage	Up to $50
Lenses
Single	100% Coverage	Up to $50
Bifocal	100% Coverage	Up to $75
Trifocal	100% Coverage	Up to $100
Frames
Frames	$150 Allowance	Up to $70
Contact Lenses (in lieu of lenses and frames)
Elective	$150 Allowance	Up to $105
Necessary	100% Coverage	Up to $210
Benefit Frequency
Eye Exam	Every 12 Months
Lenses	Every 12 Months
Frames	Every 24 Months

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