What You Get with Your Plan

Under the Affordable Care Act, any member 18 years and under gets vision care at no extra cost. Adults who are 19 and older are covered for a yearly eye exam.

• Individual and Family Plans

  	Adult Vision Exam once every 12 months		Pediatric Vision Exam once every 12 months		Pediatric Vision Materials* includes frames and lenses, or contacts once every 12 months
  	Preferred Provider	Non-Preferred Provider	Preferred Provider	Non-Preferred Provider	Preferred Provider	Non-Preferred Provider
  All HSA POS Plans	Coinsurance, 0%	Not Covered	$0 per exam	Not Covered	Deductible, $0 per item	Not Covered
  All non-HSA POS Plans	$20 per exam	Not Covered	$0 per exam	Deductible, 50%	$0 per item	$0 per item
  All non-HSA HMO Catastrophic plans	Deductible, Coinsurance	Not Covered	$0 per exam	Deductible, 50%	Deductible, $0 per item	Deductible, $0 per item

  	Adult Vision Exam once every 12 months		Pediatric Vision Exam once every 12 months		Pediatric Vision Materials* includes frames and lenses, or contacts once every 12 months
  	Preferred Provider	Non-Preferred Provider	Preferred Provider	Non-Preferred Provider	Preferred Provider	Non-Preferred Provider
  2022 HANW IND POS 2000 Gold	$20 per exam	Not Covered	$0 per exam	Dedutible, 50%	$0 per item	In Network Benefit Applies
  2022 HANW IND Summit 5750 Silver	$20 per exam	Not Covered	$0 per exam	Not Covered	$0 per item	Not Covered
  2022 HANW IND Summit HSA 6650 Bronze	Deductible, 10%	Not Covered	$0 per exam	Not Covered	Deductible, $0 per item	Not Covered

• Small Group Plans

  	Adult Vision Exam once every 12 months		Pediatric Vision Exam once every 12 months		Pediatric Vision Materials* includes frames and lenses, or contacts once every 12 months
  	Preferred Provider	Non-Preferred Provider	Preferred Provider	Non-Preferred Provider	Preferred Provider	Non-Preferred Provider
  2025 POS HSA 2000 Gold 2025 POS HSA 7150 Bronze	Deductible, 0%	Not Covered	$0 per exam	Deductible, 50%	Deductible, $0 per item	In Network Benefit Applies
  2025 POS HSA 3300 Gold	Deductible, 10%	Not Covered	$0 per exam	Deductible, 50%	Deductible, $0 per item	In Network Benefit Applies
  2025 POS HSA 3500 Silver	Deductible, 15%	Not Covered	$0 per exam	Deductible, 50%	Deductible, $0 per item	In Network Benefit Applies
  2025 POS HSA 5000 Silver	Deductible, 20%	Not Covered	$0 per exam	Deductible, 50%	Deductible, $0 per item	In Network Benefit Applies
  2025 POS 1000 Gold 2025 POS 1500 Gold 2025 POS 2000 Gold 2025 POS 2500 Gold 2025 POS 3000 Gold 2025 POS 3500 Gold 2025 POS 3800 Silver 2025 POS 5500 Silver 2025 POS 7500 Bronze 2025 POS 8900 Bronze 2025 POS 500 Platinum 2025 POS 1000 Platinum	$20 per exam	Not Covered	$0 per exam	Deductible, 50%	$0 per item	In Network Benefit Applies
  2025 HMO 2000 Gold 2025 HMO 6500 Silver	$20 per exam	Not Covered	$0 per exam	Not Covered	$0 per item	Not Covered

  	Adult Vision Exam once every 12 months		Pediatric Vision Exam once every 12 months		Pediatric Vision Materials* includes frames and lenses, or contacts once every 12 months
  	Preferred Provider	Non-Preferred Provider	Preferred Provider	Non-Preferred Provider	Preferred Provider	Non-Preferred Provider
  2025 POS HSA 2000 Gold 2025 POS HSA 7150 Bronze	Deductible, 0%	Not Covered	$0 per exam	Deductible, 50%	Deductible, $0 per item	In Network Benefit Applies
  2025 POS HSA 3300 Gold	Deductible, 10%	Not Covered	$0 per exam	Deductible, 50%	Deductible, $0 per item	In Network Benefit Applies
  2025 POS HSA 3500 Silver	Deductible, 15%	Not Covered	$0 per exam	Deductible, 50%	Deductible, $0 per item	In Network Benefit Applies
  2025 POS HSA 5000 Silver	Deductible, 20%	Not Covered	$0 per exam	Deductible, 50%	Deductible, $0 per item	In Network Benefit Applies
  2025 POS 1500 Gold 2025 POS 2000 Gold 2025 POS 2500 Gold 2025 POS 3000 Gold 2025 POS 3500 Gold 2025 POS 3800 Silver 2025 POS 5500 Silver 2025 POS-C 2800 Silver	$20 per exam	Not Covered	$0 per exam	Deductible, 50%	$0 per item	In Network Benefit Applies
  2025 HMO 1000 Gold 2025 HMO 2000 Gold 2025 HMO 2500 Gold 2025 HMO 500 Platinum 2025 HMO 6500 Silver	$20 per exam	Not Covered	$0 per exam	Not Covered	$0 per item	Not Covered

  	Adult Vision Exam once every 12 months		Pediatric Vision Exam once every 12 months		Pediatric Vision Materials* includes frames and lenses, or contacts once every 12 months
  	Preferred Provider	Non-Preferred Provider	Preferred Provider	Non-Preferred Provider	Preferred Provider	Non-Preferred Provider
  2022 HANW POS HSA 6850 Bronze	Deductible, 0%	Not Covered	$0 per exam	Deductible, 50%	Deductible, $0 per item	In Network Benefit Applies
  2022 HANW POS HSA 5000 Silver	Deductible, 10%	Not Covered	$0 per exam	Deductible, 50%	Deductible, $0 per item	In Network Benefit Applies
  2022 HANW POS HSA 3000 Silver	Deductible, 20%	Not Covered	$0 per exam	Deductible, 50%	Deductible, $0 per item	In Network Benefit Applies
  2022 HANW POS 1000 Gold 2022 HANW POS 1500 Gold 2022 HANW POS 2000 Gold 2022 HANW POS 3000 Gold 2022 HANW POS 4600 Silver	$20 per exam	Not Covered	$0 per exam	Deductible, 50%	$0 per item	In Network Benefit Applies

  	Adult Vision Exam once every 12 months			Pediatric Vision Exam once every 12 months			Pediatric Vision Materials* includes frames and lenses, or contacts once every 12 months
  	Preferred Provider	Non-Preferred Provider	Tier 1	Preferred Provider	Non-Preferred Provider	Tier 1	Preferred Provider	Non-Preferred Provider	Tier 1
  2022 Simplete Memorial HMO 4000 HSA Silver	Deductible, 30%	Not Covered	Deductible, 20%	$0 per exam	Not Covered	$0 per exam	Deductible, $0 per item	Not Covered	Deductible, $0 per item
  2022 Simplete Memorial HMO 6500 HSA Bronze	Deductible, 50%	Not Covered	Deductible, 40%	$0 per exam	Not Covered	$0 per exam	Deductible, $0 per item	Not Covered	Deductible, $0 per item
  2022 Simplete Memorial POS 1000 Platinum 2022 Simplete Memorial POS 1500 Gold 2022 Simplete Memorial POS 3000 Gold 2022 Simplete Memorial POS 3850 Silver	$20 per exam	Not Covered	$20 per exam	$0 per exam	Deductible, 50%	$0 per exam	$0 per item	$0 per item	$0 per item
  2022 Simplete Memorial POS 6000 Bronze	Deductible, 50%	Not Covered	Deductible, 35%	$0 per exam	Deductible, 50%	$0 per exam	$0 per item	$0 per item	$0 per item
  2022 Simplete Memorial HMO 2500 Gold 2022 Simplete Memorial HMO 500 Platinum	$20 per exam	Not Covered	$20 per exam	$0 per exam	Not Covered	$0 per exam	$0 per item	Not Covered	$0 per item

• Extra Vision Coverage You Can Buy

  You can also buy extra vision benefits from VSP for your individual plan. Their strong network of doctors covers more than 56 million members across the country.

  With these extras, everyone on your plan 19 years and older gets:

  • An eye exam
  • Unlimited discounts on:
    • Glasses lenses
    • Glasses frames
    • Contact lenses
    • Laser surgery

  All this comes at the following prices, tailored to suit your needs:

  • Small Group Plan - $3.22 per month for a single member; $6.44 for a single member +1 (dependent); or $10.38 for a single member +2 or more (dependents). There's also no deductible and a $130 allowance for frames and contact lenses.
  • Individual Plan - $3.98 per month for a single member; $7.95 for a single member +1 (dependent); or $12.80 for a single member +2 or more (dependents). There's also no deductible and a $130 allowance for frames and contact lenses.

  
  

  Find a Provider

   

  Search VSP

  *Members can choose any provider for vision materials. We cover material costs up to our maximum allowable cost. If a provider bills at more than maximum allowable cost, members are responsible for paying the difference.

  WellVision Exam®	Thorough Eye Exam Covered in Full* Once Every 12 Months
  Lenses	Glass or plastic, single-vision, lined bifocal, lined trifocal lenses covered in full* 20% off all non-covered lens options 20% off additional pairs of prescription glasses (unlimited) 20% off non-prescription sunglasses (unlimited)
  Frames	Frames covered in full* up to the retail allowance of $130 for a wide selection of frames 20% off any amount above the $130 allowance (once every 12 months)
  Contact Lenses	15% off contact lens services (excluding materials) Instead of eyeglasses, elective contact lens services and materials covered up to $130 toward any type of prescription contact lenses Necessary contact lenses covered in full* for members who have a specific condition for which contact lenses provide better sight correction
  Laser VisionCare Program	VSP-contracted laser centers provide discounts for laser surgery including PRK, LASIK, and Custom LASIK** Discounts average 15% off or 5% off if the laser center offers a promotional price***

  *Except for any applicable copayment, including a $20 copayment for the exam. There is no separate copayment for lenses, frames, or contacts.
  **Custom LASIK coverage only available using wavefront technology with the microkeratome surgical device. Other LASIK procedures may be performed at an additional cost to the member.
  ***Laser VisionCare discounts are only available from VSP-contracted facilities. Preauthorization required.

   

  For details on specific vision services and limits, see your plan's policy (under Vision Care).