Vision
Healthy eyes and clear vision are an important part of your overall health and quality of life. You may enroll yourself and your eligible dependents or you may waive vision coverage. You do not have to be enrolled in medical coverage to elect vision coverage or cover the same dependents under medical and vision.
Although vision care services and supplies are covered in-network and out-of-network, your benefits are generally greater when you use in-network providers. Your costs are based on the family members you choose to cover.
Guardian Vision (VSP)
Plan Information
Plan Name: Guardian Vision (VSP)
Policy Number: 00026971
Effective Date: 11/01/2024
Provider Network: VSP – Signature Full Feature
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
In-Network
Exams
$10 copay
Single Vision Lenses
$10 copay
Bifocal Lenses
$10 copay
Trifocal Lenses
$10 copay
Frames
$250, 20% discount over $250
Contacts (in lieu of glasses)
Amount over $250 (copay waived)
Frequency
Exams
Once every 12 months
Lenses
Once every 12 months
Frames
Once every 12 months
Contacts
Once every 12 months
Out-of-Network Reimbursement
Exams
Up to $50
Single Vision Lenses
Up to $48
Bifocal Lenses
Up to $67
Trifocal Lenses
Up to $86
Frames
Up to $48
Contacts (in lieu of glasses)
Up to $130
Frequency
Exams
Once every 12 months
Lenses
Once every 12 months
Frames
Once every 12 months
Contacts
Once every 12 months