Vision Benefits

Benefit Description

This benefit is available to all qualified participants and their eligible dependents who have selected Kaiser Permanente - HMO, Western Health Advantage – HMO or Aetna– PPO for their medical coverage. Vision benefits are provided by Vision Service Plan, Group Number 12102843.

Eligibility Requirements

Primary enrollee, spouse and eligible dependent children to the end of the month dependent turn age 26.

Plan Highlights

Exam (every 12 months) covered in full
Prescription Glasses:
Lenses (every 12 months)

single vision lined bifocal and lined trifocal lenses

covered in full
Frames (every 24 months) $120 allowance plus 20% off any out-of-pocket costs

OR

Contacts (every 12 months) $105 allowance (also applied toward fitting and evaluation exam)

COPAYS

Exam (every 12 months)
$10
Prescription Glasses
$25
Contacts (every 12 months)

none

Covered Services

  1. Vision examination – Includes a refraction test to determine the need for glasses, analysis for binocularity, and testing of the overall health of the eyes and related optic structures. This benefit is available once every 24 months from the last date of service. Materials Covered 1. Frames and Lenses – Benefits for lenses are available once every twenty-four (24) months from the last date of service. Benefits for frames are available once every twenty-four (24) months from the last date of service. Before you select your frames or lenses, check with your VSP provider to find out which frames and lenses are fully covered under this Plan.
  2. Contact Lenses – Most contact lenses are purchased for cosmetic reasons and therefore are considered “elective.” The maximum benefit payment for “elective” contact lenses is $105. This benefit is available once every twenty-four (24) months from the last date of service and is in lieu of the lens and frame benefit. 35
  3. Necessary Contact Lenses – Are considered for people following cataract surgery, keratoconus, certain conditions of anisometropis, and in situations where vision cannot be satisfactorily corrected using spectacle lenses. “Medically Necessary” contacts furnished by a VSP member doctor may be covered in full less the copayment but only if the member doctor secures prior approval from VSP.

Value

Dollar for dollar you get the best value from your VSP benefit when you visit a VSP network doctor. If you decide not to see a VSP doctor, copays still apply. You’ll also receive a lesser benefit and typically pay more Out-of-Pocket. You are required to pay the provider in full at the time of your appointment and submit a claim to VSP for partial reimbursement. If you decide to see a provider, not in the VSP network, call us first at 800-877-7195.

Reimbursement Amounts
Exam up to $45
Lenses – single vision up to $45
Lenses – bifocal up to $65
Lenses – trifocal up to $85
Frame up to $47
Contact Lenses up to $105

Other Discounts

  1. Laser Vision Correction Discounts
  2. Prescription Glasses
    • Up to 20% savings on lens extras such as scratch-resistant and anti-reflective coatings and progressives
    • 20% off additional prescription glasses and sunglasses
  3. Contacts
    • Exclusive pricing on annual supplies of popular brands
    • 15% discount off the cost of contact lens exam (fitting and evaluation)

Documents

 

Useful Links