Lenses

2020 and 2021 Plan Year Information

VSP Option AVSP Option B
Note

The figures in the chart below reflect what the Plan pays, with the exception of deductibles and out-of-pocket maximums.

Lenses: Single

In-Network:
100% after $20 copay for lenses and frames

Out-of-Network:
Up to $50 allowance after $20 copay

In-Network:
100% after $20 copay for lenses and frames

Out-of-Network:
Up to $40 allowance after $20 copay

Lenses: Lined Bifocal

In-Network:
100% after $20 copay for lenses and frames

Out-of-Network:
Up to $75 allowance after $20 copay

In-Network:
100% after $20 copay for lenses and frames

Out-of-Network:
Up to $60 allowance after $20 copay

Lenses: Lined Trifocal

In-Network:
100% after $20 copay for lenses and frames

Out-of-Network:
Up to $100 after $20 copay

In-Network:
100% after $20 copay for lenses and frames

Out-of-Network:
Up to $75 allowance after $20 copay

Lenses: Progressive

In-Network:
100% after $20 copay for lenses and frames

Out-of-Network:
Up to $75 allowance after $20 copay

In-Network:
100% after $20 copay for lenses and frames

Out-of-Network:
Up to $60 allowance after $20 copay

Optional Lens Types and Treatments

In-Network:
100%

Out-of-Network:
5%

In-Network:
100%

Out-of-Network:
5%

Elective Contact Lenses (instead of eyeglasses)

In-Network:
Up to $250 and $60 max copay for contact lens exam

Out-of-Network:
Up to $105 (includes exam and fitting)

In-Network:
Up to $150 and $60 max copay for contact lens exam

Out-of-Network:
Up to $100 (includes exam and fitting)

Medically Necessary Contact Lenses with VSP Approval

In-Network:
100% after $20 copay for lenses once every calendar year

Out-of-Network:
Up to $210 allowance after $20 copay

In-Network:
100% after $20 copay for exam and $20 copay for lenses once every two years

Out-of-Network:
Up to $210 allowance after $20 copay

Finding a VSP Provider

If you are enrolled in the vision plan, you may receive services and supplies from the vision care provider of your choice. However, you will pay more when you use an out-of-network provider. You can find a list of in-network providers on the VSP website.