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High Plan and Low Plan Options on the VSP Choice Network
Ameritas makes using your benefits a snap. Create an account, and they will give you access and tools to manage your vision plan.
(800) 487-5553 | vsp.com/eye-doctor | Group # 010-60642
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Vision Plans |
Stay in network to save
Visit a vision provider in the network to maximize your savings. These providers have agreed to reduced fees, and you won't get charged more than your expected share of the bill. Find a provider at vsp.com/eye-doctor.
Out-of-network Coverage
While out-of-network coverage is available for this plan, please be aware that you will be responsible for paying the cost + any applicable copay upfront and then submitting your claim to UnitedHealthcare to be reimbursed up to the maximum plan reimbursement for a covered service.
Visit a vision provider in the network to maximize your savings. These providers have agreed to reduced fees, and you won't get charged more than your expected share of the bill. Find a provider at vsp.com/eye-doctor.
Out-of-network Coverage
While out-of-network coverage is available for this plan, please be aware that you will be responsible for paying the cost + any applicable copay upfront and then submitting your claim to UnitedHealthcare to be reimbursed up to the maximum plan reimbursement for a covered service.
LOW VISION PLAN - VSP CHOICE NETWORK
In-Network
Out-of-Network
Routine Vision Exam
You pay $10 copay
Plan reimburses up to $45
Contact Fitting & Evaluation
You pay $60 copay
Not covered
Frequency
Frames
Lenses
Contact Lenses
Lenses
Contact Lenses
Once every 24 months
Once every 12 months
Once every 12 months
Once every 12 months
Once every 12 months
Eyeglasses
Single Vision Lenses 1
You pay $25 copay
Plan reimburses up to $30
Lined Bifocal Lenses 1
You pay $25 copay
Plan reimburses up to $50
Lined Trifocal Lenses 1
You pay $25 copay
Plan reimburses up to $65
Frame Allowance
Plan provides a $105 allowance 2
Plan reimburses up to $70
Contact Lenses
Prescription Medically Necessary
Plan pays 100% after $25 copay
Plan reimburses up to $210
Prescription Elective (in lieu of glasses)
Plan provides a $105 allowance 3
Plan reimburses up to $105
1 Limited to standard, uncoated plastic lenses
2 A discount is applied to frames over the allowance
3 Based off of last date of service
This information is designed to help you choose a benefit plan for 2024 only. Please refer to the Plan Documents provided by the carrier for information regarding coverage, limitations and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
2 A discount is applied to frames over the allowance
3 Based off of last date of service
This information is designed to help you choose a benefit plan for 2024 only. Please refer to the Plan Documents provided by the carrier for information regarding coverage, limitations and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
EMPLOYEE COST PER PAY PERIOD
Employee Only
Employee + One Dependent
Employee + Family
$0.00
$0.75
$1.50
Stay in network to save
Visit a vision provider in the network to maximize your savings. These providers have agreed to reduced fees, and you won't get charged more than your expected share of the bill. Find a provider at vsp.com/eye-doctor.
Out-of-network Coverage
While out-of-network coverage is available for this plan, please be aware that you will be responsible for paying the cost + any applicable copay upfront and then submitting your claim to UnitedHealthcare to be reimbursed up to the maximum plan reimbursement for a covered service.
Visit a vision provider in the network to maximize your savings. These providers have agreed to reduced fees, and you won't get charged more than your expected share of the bill. Find a provider at vsp.com/eye-doctor.
Out-of-network Coverage
While out-of-network coverage is available for this plan, please be aware that you will be responsible for paying the cost + any applicable copay upfront and then submitting your claim to UnitedHealthcare to be reimbursed up to the maximum plan reimbursement for a covered service.
LOW VISION PLAN - VSP CHOICE NETWORK
In-Network
Out-of-Network
Routine Vision Exam
You pay $10 copay
Plan reimburses up to $45
Contact Fitting & Evaluation
You pay $60 copay
Not covered
Frequency
Frames
Lenses
Contact Lenses
Lenses
Contact Lenses
Once every 24 months
Once every 12 months
Once every 12 months
Once every 12 months
Once every 12 months
Eyeglasses
Single Vision Lenses 1
You pay $25 copay
Plan reimburses up to $30
Lined Bifocal Lenses 1
You pay $25 copay
Plan reimburses up to $50
Lined Trifocal Lenses 1
You pay $25 copay
Plan reimburses up to $65
Frame Allowance
Plan provides a $180 allowance 2
Plan reimburses up to $70
Contact Lenses
Prescription Medically Necessary
Plan pays 100% after $25 copay
Plan reimburses up to $210
Prescription Elective (in lieu of glasses)
Plan provides a $180 allowance 3
Plan reimburses up to $105
1 Limited to standard, uncoated plastic lenses
2 A 30% discount is applied to frames over the allowance
3 Based off of last date of service
This information is designed to help you choose a benefit plan for 2024 only. Please refer to the Plan Documents provided by the carrier for information regarding coverage, limitations and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
2 A 30% discount is applied to frames over the allowance
3 Based off of last date of service
This information is designed to help you choose a benefit plan for 2024 only. Please refer to the Plan Documents provided by the carrier for information regarding coverage, limitations and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
EMPLOYEE COST PER PAY PERIOD
Employee Only
Employee + One Dependent
Employee + Family
$0.94
$2.09
$3.92
