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WellVision Eye exam 

• In-network: $10 copay/visit 
• Out-of-network: Reimbursement up to $45 

Essential medical eye care 

• In-network:  
  • $0 copay per retinal screening for members with diabetes 
  • $20 copay per exam for additional exams and services beyond routine care to treat immediate issues (e.g., pink eye; sudden changes in vision) or monitor ongoing conditions (e.g., dry eye, diabetic eye disease, glaucoma)  
    • Coordination with your medical coverage may apply. Ask your eye doctor for details. 

Glasses 

• In-network: $25 copay, covers frames and lenses. 

Frames 

(any available frame at provider location) 

• In-network:  
  • $140 frame allowance; $190 featured frame brands allowance 
  • 20% savings on the amount over your allowance 
• Out-of-network: Reimbursement up to $47 

Lenses 

• In-network: Covered without additional copay;  
  • Single vision, lined bifocal and lined trifocal lenses 
  • Linticular lenses 
  • Polycarbonate lenses- Children 
  • Standard progressive lenses 
  • Tint (Pink I and II) 
• Out-of-network: Reimbursement up to:  
  • Single vision, lined bifocal and lined trifocal lenses: up to $45; $65; $85 
  • Lenticular lenses: up to $125 
  • Progressive lenses: up to $65 

For additional lens options, and costs, see the Member Benefits Summary listed below 

Contact lens fitting and follow-up 

• In-network: Up to $40 maximum copay 

Contacts (materials only) 

• In-network: $140 allowance for contacts; copay does not apply  
  • Contact lenses (conventional and disposable): $140 allowance, copay does not apply 
  • Necessary contact lenses: $25 copay, paid in full after copay 
• Out-of-network: reimbursement (up to):  
  • Contact lenses (conventional and disposable): up to $125 
  • Necessary contact lenses: up to $210 

LightCare 

With VSP LightCare, you can use your frame and lens benefit to get non-prescription eyewear from your VSP network doctor. 

• In-network: 
  • $140 allowance for ready-made non-prescription sunglasses, or ready-made non-prescription blue light filtering glasses, instead of prescription glasses or contacts 
  • $25 copay 

Routine retinal screening 

• No more than a $39 copay on routine retinal screening as an enhancement to a WellVision exam. 

Laser vision correction 

• Average 15% off the regular price or 5% off the promotional price; discounts only available from contracted facilities