Vision Options

2020 Plan Year Information

VSP Vision Plan

The Firm offers one vision plan through Vision Service Plan (VSP).

If you are a US benefits-eligible expatriate or US benefits-eligible international employee, you may elect vision coverage under the VSP Vision Plan. If you participate in VSP and visit a non-VSP provider while abroad, you will be reimbursed at the out-of-network level.

You will be required to submit a claims form and itemized receipt (translated in English) to obtain reimbursement.

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.

Eye Exam

In-Network:
100% after $20 copay

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

In-Network:
100% after $20 copay

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

Contact Lens Fitting

In-Network:
Up to $60 copay

Out-of-Network:
Up to $100 maximum reimbursement (includes fitting and evaluation)

In-Network:
Up to $60 copay

Out-of-Network:
Up to $100 maximum reimbursement (includes fitting and evaluation)

Frames

In-Network:
Up to $250 after $20 copay plus 20% discount on cost exceeding $250 once every calendar year

Out-of-Network:
Up to $70 allowance after $20 copay

In-Network:
Up to $150 after $20 copay plus 20% discount on cost exceeding $150 every two years

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

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

Diabetic Eyecare Plus

$20 copay for additional eyecare services specifically for members with diabetic eye disease, glaucoma or age-related macular degeneration (AMD)

$20 copay for additional eyecare services specifically for members with diabetic eye disease, glaucoma or age-related macular degeneration (AMD)

Laser surgery

Discounts of 10 to 25%, depending on location.

Discounts of 10 to 25%, depending on location.

Vision Benefits

The benefits in the chart above are available once per calendar year, except for frames, which are covered once every two calendar years. Many services are covered at 100% after copay when you use in-network providers. You may also receive discounts on services at participating retail chain stores such as Cohen’s Fashion Optical, Costco and others.

Notes About Lenses and Frames

The total copay for lenses generally applies to both eyeglass lenses and/or frames. You may select from a variety of optional lens types, as outlined in the Health Benefits and Insurance SPD.

Lenses are considered medically necessary for certain eye conditions that prohibit the use of glasses, including aphakia, anisometropia, high ametropia, nystagmus and keratoconus.

If you purchase frames from Costco, the frame allowance is $135 for VSP Option A and $80 for VSP Option B.

Other Vision Services

Services such as laser surgery, low vision supplemental testing, additional prescription and nonprescription glasses and sunglasses, and contact lens exams are covered to the extent described in the schedule of benefits in the Health Benefits and Insurance SPD.

Vision Contributions

You pay the full cost of vision coverage. Your contributions are deducted from your pay on a before-tax basis.

2019:

 Yourself OnlyYourself + Spouse/Domestic PartnerYourself + ChildrenYourself + Family
VSP Vision Plan A Cost$8.90$17.80$19.04$30.44
VSP Vision Plan B Cost$6.08$12.15$13.00$20.77

2020:

 Yourself OnlyYourself + Spouse/Domestic PartnerYourself + ChildrenYourself + Family
VSP Vision Plan A Cost$8.90$17.80$19.04$30.44
VSP Vision Plan B Cost$6.57$13.12$14.04$22.43

*The costs shown are per paycheck contributions. For the monthly cost, double the amounts shown.

If you are covering a domestic partner or the children of a domestic partner, the final determination of the tax status of a dependent is made by the IRS. As a result, there is no guarantee that the IRS will not impose a tax on the value of coverage.