San Marcos Unified School District Open Enrollment October 16, 2017 – November 09, 2017 Certificated & Management Employees Open Enrollment Guide Questions? Please contact: Kitty Ross Benefits Analyst Phone: 760-752-1241 Fax: 760-752-1138 [email protected]PLEASE READ INSIDE FOR FURTHER DETAILS ABOUT THE 2018 BENEFIT CHANGES Important Dates: Site Visits • See the Open Enrollment Calendar Walk-In Meetings Can’t make it to your site visit? Get your questions answered at the walk-in meetings at the District Office • 11/08/17 2:30 P.M. to 5:00 P.M. • 11/09/17 2:30 P.M. to 5:00 P.M. (Flu Shots and Last Day of Open Enrollment) Health Fair • 10/26/17 at Discovery Elementary 4:00 P.M. – 6:00 P.M. • Flu Shots, Health Screenings, Healthy Vendors, Raffles
Transcript
San Marcos Unified School District
Open Enrollment October 16, 2017 – November 09, 2017
• See the Open Enrollment Calendar Walk-In Meetings
Can’t make it to your site visit? Get your questions answered at the walk-in meetings at the District Office
• 11/08/17 2:30 P.M. to 5:00 P.M. • 11/09/17 2:30 P.M. to 5:00 P.M. (Flu Shots and Last Day of
Open Enrollment)
Health Fair
• 10/26/17 at Discovery Elementary 4:00 P.M. – 6:00 P.M. • Flu Shots, Health Screenings, Healthy Vendors, Raffles
2018 Certificated/Mgt Employee Contributions
Payroll Deduction
Kaiser Permanente HMO Single 2 Party FamilyKaiser $20 $0.00 $0.00 $0.00Kaiser $20 $39.55 $39.55 $39.55
UnitedHealthcare HMO (Package D) Single 2 Party FamilyNetwork 1 $101.00 $199.00 $270.00Network 1 $140.55 $238.55 $309.55
UnitedHealthcare HMO (Package D) Single 2 Party FamilyNetwork 2 $264.00 $525.00 $731.00Network 2 $303.55 $564.55 $770.55
UnitedHealthcare HMO (Package D) Single 2 Party FamilyNetwork 3 $425.00 $846.00 $1,182.00Network 3 $464.55 $885.55 $1,221.55
Alliance HMO (with $500 HRA) Single 2 Party FamilyAlliance $189.00 $317.00 $415.00Alliance $228.55 $356.55 $454.55
UnitedHealthcare Choice Plus PPO w/HRA Single 2 Party FamilyPPO $809.00 $1,566.00 $2,180.00PPO $848.55 $1,605.55 $2,219.55
(includes Delta Premier , VSP, & Group Life)
Premier Dental Closed to New Enrollments
(includes Delta PPO , VSP, & Group Life)(includes Delta Premier , VSP, & Group Life)
Premier Dental Closed to New Enrollments
Premier Dental Closed to New Enrollments
Premier Dental Closed to New Enrollments
Premier Dental Closed to New Enrollments
(includes Delta PPO , VSP, & Group Life)(includes Delta Premier , VSP, & Group Life)
(includes Delta PPO , VSP, & Group Life)(includes Delta Premier , VSP, & Group Life)
(includes Delta PPO , VSP, & Group Life)(includes Delta Premier , VSP, & Group Life)
Health Plan/Benefit Packages
(includes Delta PPO , VSP, & Group Life)(includes Delta Premier , VSP, & Group Life)
(includes Delta PPO , VSP, & Group Life)
Premier Dental Closed to New Enrollments
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OPEN ENROLLMENT FOR CERTIFICATED & MANAGEMENT EMPLOYEES Open enrollment will begin on October 16, 2017 and will end on November 9, 2017.
Open Enrollment is the time of year employees can change their health plan selection, an opportunity to add or drop eligible dependents, enroll/re-enroll in the Flex 125 plan (FSA), and enroll in other voluntary benefits.
Summary of 2018 Plan Changes Certificated & Management employees will be offered the Kaiser $20, UnitedHealthcare HMO Network 1, 2 or 3 Package D, UnitedHealthcare Alliance HMO with $500 HRA, UnitedHealthcare PPO with $500 HRA and Optum Health Chiropractic and Acupuncture. Kaiser Plan $20 No Plan Changes
UnitedHealthcare HMO Plan D Network 1, 2, 3 No Plan Changes
Alliance Plan Emergency Room Visit – From 20% of Out of Pocket Maximum to $300 Copay waived if admitted
Alliance Plan HMO with $500 HRA Expanded Medical Groups: Mercy Physicians Medical- Scripps Care Rady Children’s Health Network Scripps Clinic Scripps Coastal Medical Center Scripps Physicians Medical Group UCSD Medical Group
Searching for UnitedHealthcare HMO providers: http://csveba.welcometouhc.com/uhc.com Select one of the Performance HMO Networks Search by Doctor or Medical Group UnitedHealthcare Select Plus PPO (SD) 80/50 with $500 HRA A PPO plan that empowers members to choose premium quality providers and lower cost facilities. Premium Tier 1 Network Provider are identified as the highest performing provider in 27 specialties
and service. (Note: while oncology and dermatology specialists are not identified in these 27 specialties, if they are automatically included in the Premium Tier 1 network)
Network Providers require co-insurance payments (for which you are billed) Outside-Network Providers require higher co-insurance payments (for which you are billed)
All UnitedHealthcare participants will receive a new medical ID card(s) for the 2018 Plan year.
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Summary of 2018 Plan Changes - Continued Express Scrips - All UnitedHealthcare Plans On November 1, 2017, Express Scripps Inc. will extend a clinical review process to include certain drugs, including: Long-acting opioids Certain asthma inhalers Drugs for opioid dependence, and Certain anti-clotting medications A review process will require members to change drugs unless their physician documents that the drug is necessary. Express Scripps Inc. (ESI) will notify members directly of the changes. On January 1, 2018, certain members will begin to receive cholesterol drugs through mail/Smart 90 for no copay. This is a new recommendation by the US Preventive Services Tasks Force for members that meet the following criteria: Adult age 40-75 without a history of cardiovascular disease Presence of a health risk factor such as hypertension or smoking Copays are waived only for low/moderate dose cholesterol drugs Not high intensity, which includes (for example, atorvastatin 40mg or rosuvastatin 20-40mg) Express Scripps Advantage Networks (EAN) There are several types of Express Scripts network pharmacies. The copay and coinsurance amounts are based on which network the pharmacy falls under. Members can choose from the following: Short-Term Drugs (up to a 30-day supply) Use Express Scripts Network (EAN) for lowest cost Costco - Rite Aid - Ralphs - Vons - Kmart - Walmart Non EAN – Walgreens – CVS – Target Maintenance Drugs (up to a 90-day supply) Use Smart 90 Pharmacy or Express Scripts Home Delivery for lowest cost Costco – Rite Aid or Express Scripts Home Delivery Non EAN – Walgreens – CVS – Target
Optum Health for Chiropractic Care and Acupuncture Services
Copays will stay the same ($10, $20, or $30) Depending on your Primary Care Physician copay Only Optum chiropractors and acupuncturists are eligible for reimbursement under the plan Unlimited visits (subject to medical necessity) and X-rays as authorized. To locate a provider:
1) Go to the Provider Locator search at: www.myoptumhealthphysicalhealthof ca.com look for VEBA in the column heading
2) Call Optum Member Services at 1-800-428-6337 3) Call the provider directly to schedule an appointment, and verify they are part of the Optum network
for VEBA
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FLEXIBLE SPENDING ACCOUNTS/SECTION 125 PLANS
Enrollment is not continuous - employees that wish to enroll in this plan must re-enroll every year This is the time to enroll, or re-enroll if you currently participate, in the flexible spending account program. This plan allows you to pre-tax income for dependent care reimbursement and medical expenses.
To enroll or re-enroll in the plan, employees must meet with a representative from American Fidelity. Representatives will be available at every Open Enrollment site visit, the walk-in meetings at the District Office and at the Health/Benefit Fair. VOLUNTARY PLAN ENROLLMENTS The following plans are available for enrollment during Open Enrollment. If you are interested in these plans, please request additional information or visit the SMUSD website*.
Legal Aid Plan Long Term Care Insurance Voluntary Life Insurance Critical Illness Insurance Liberty Mutual Home, Renters, and Auto Insurance
American Fidelity Plans – Please see an American Fidelity representative
Accident Insurance Disability Insurance Cancer Insurance Life Insurance
Getting Your Questions Answered Please visit the SMUSD website for additional information. The website includes supplementary information regarding all of the plans. Go to www.smusd.org, click on Departments, Benefits, Open Enrollment.
Come to a Site Visit: Please see the Open Enrollment calendar for the dates and times. Walk-In Meetings at the District Office: Can’t make it to your site visit? Get your questions answered at the walk-in basis meetings at the District Office. The meetings will be in the Human Resources Conference room (2nd floor) on the following dates:
October 26th Annual Health Fair 4:00 PM to 6:00 PM
Discovery Elementary 730 Applewilde San Marcos CA 92078
November 8th 2:30 PM to 5:00 PM District Office
November 9th 2:30 PM to 5:00 PM District Office (Flu Shots available and Last Day of Open Enrollment)
How to Make Changes Employees do not have to complete an enrollment if they are not making any changes
ONLINE ENROLLMENT: Employees can enroll in any of the health plans (health plans only) by using the VEBA online enrollment tool. If enrolling in a UnitedHealthcare plan you will need to have your primary care doctor name and medical group ID# for yourself and or your dependents. Click on the “Online Enrollment” link. The link says, “VEBA Members: Click here to Enroll Online”.
Enter your Pin and Password. If you forgot your pin and password or do not have one, click on the link that says “New to Online Enrollment or forgot your Login Information?”
Then follow the instructions on the screen To Search for UnitedHealthcare HMO providers: http://csveba.welcometouhc.com/uhc.com Select one of the Performance HMO Networks and Search by Doctor or Medical Group PAPER ENROLLMENT FORM: Print a paper enrollment form from the SMUSD website or pick one up at your Open Enrollment site visit.
ADDING NEW DEPENDENTS: Health Plan – To add an eligible dependent to your medical health plan, please use the Online Open
Enrollment Tool or print a paper enrollment form from the SMUSD website. Send proof of dependent eligibility to HR-Benefits or upload when enrolling online.
Delta Plan – To add an eligible dependent to your Delta Dental plan, please complete an enrollment/change form. Employees can print the form from the SMUSD website. Dependent children age 19 - 24 must be unmarried full time students to be eligible to be enrolled in the dental, vision or group life insurance plans. Dependent children age 25+ are not eligible for the dental, vision or group life insurance.
Vision Plan – No form needed for adding a dependent to Vision, dependents enrolled in Dental will be auto enrolled in the Vision Service Plan.
Group Life Insurance – To update your beneficiary for your District life policy go the SMUSD website to print the beneficiary change form.
CHANGING YOUR DELTA PREMIER DENTAL PLAN TO THE DELTA PPO PLAN: The Delta Dental Premier plan has been closed to new enrollments since 2004
Employees can change to the Delta PPO plan. Please print an enrollment form from the SMUSD website or pick one up from your site visit. Once enrolled in the PPO plan Employees cannot switch back to the Premier plan
Employees can verify which Delta Dental plan they have by calling Delta Dental or by registering at, www.deltadentalins.com Delta Dental Phone Number 1-800-765-6003
Health Care Reform - Affordable Care Act: The Affordable Care Act allows young adults to stay on their parent’s health plan until age 26. The dependent does not have to be a full-time student and marital status does not prohibit the dependent’s eligibility. The Affordable Care Act rule only applies to medical health care coverage.
ALL ENROLLMENT FORMS MUST BE RECEIVED BY NOVEMBER 9, 2017 - NO EXCEPTIONS
Medial Health Plan: Young adult health insurance coverage has been extended to eligible dependents up to age 26. Eligible dependents are not required to be full-time students to be covered on the employee’s health plan. An eligible dependent can be married and is eligible to be covered on the employee’s health plan.
Dental, Vision & Group Life: Your unmarried children who are between the ages of 19 and 24, and are full-time students carrying at least 12 units at an accredited college, university, or a State Department of Education-approved vocational/technical school. Your unmarried children who are deemed disabled by their physician and approved by your carrier. The disability must have occurred prior to age 19.
Eligible children include:
Your natural and adopted children
Stepchildren, if you are married to your stepchildren’s parent. If you and your spouse divorce, your former dependent stepchildren are no longer eligible for coverage
Children of your domestic partner. If you and your domestic partner separate, the children of your former domestic partner are no longer eligible for coverage
Children for whom you have permanent legal guardianship issued by a court of law
Your children who must be covered under a Qualified Medical Child Support Order
Stepchildren who must be covered under a Qualified Medical Child Support Order
Dependent Eligibility Verification Documents Please note: Employees are required to provide documentation when adding a new dependent to their benefits. For new dependents, dependent eligibility documentation must be turned in by the Open Enrollment deadline, November 9, 2017.
Spouse Marriage Certificate or first page of 2015 or 2016 tax forms
Birth Child Birth Certificate or first page of 2015 or 2016 tax forms
Step Children Birth certificate of stepchild listing employee’s current spouse as the parent of the stepchild.
Adopted, Foster Children, or Legal Guardianship
Court documents showing legal responsibility for the child(ren).
Dental, Vision & Life Over age dependents (age 19-24)
Birth certificate or first page of 2015 or 2016 tax form And
School transcripts for the most recent semester showing enrollment in at least 12 semester units or the college’s full-time qualifying units.
Domestic Partner Domestic Partner Registration (Domestic Partners cannot be of the opposite sex unless one is over the age of 62.) State California guidelines web site may be found at: www.ss.ca.gov/dpregistry/index.htm.
UHC Medical Plans
In an HMO, you see your PCP first for most medical issues. You do not need a referal for mental health, chiropractic or OBGYN services.
To find a provider or facility:1. Go to Welcometouhc.com/csveba2. Scroll down to choose from the plan options3. Choose the appropriate network and click
“Search the network”4. Click “okay”5. Click “continue”6. Search by Name, Specialty, or Medical Group
Performance HMO
Medical groups are ranked in three networks based on quality scores from the California Office of the Patient Advocate (opa.ca.gov) and what they charge for services. Copays vary by network. Medical groups in Network 1 have the highest performance ratings and lowest copays.
SignatureValue Alliance HMO
This HMO benefit plan is a health plan that offers access to physicians selected based on their ability to guide their patients to the care and resources that help promote better health outcomes and lower costs. This plan combines a high-deductible health plan with a VEBA-funded account that helps members meet your deductible. Members can use your HRA funds immediately to help cover the initial deductible expenses
Your district offers a number of different medical options. Please review the following informationto help select the best plan for you and your family.
HMO Plans
In an HMO, you must see your Primary Care Physician (PCP) first for most medical issues. Your PCP will refer you to any specialists you may need to see. When selecting your plan, remember: • You and your dependents must enroll in the same network but can select
different PCPs within that network• Your network election is effective for the entire year – you may change PCPs
within the network but you cannot change networks until the next enrollmentperiod
Kaiser
A high quality HMO program that utilizes the Kaiser Permanente network of hospitals and physicians.
AVAILABLE PLANS
YOUR 2018 BENEFIT OPTIONS
2018 CHANGES
Kaiser HMOUHC Performance HMO D
Network 1 Network 2Network 3
UHC SignatureValue Alliance HMOUHC PPO
PPO Plans
In a PPO, the plan offers both in-network and out-of-network coverage. You can see any doctor but will pay less when you use doctors in the UHC Select Plus network. For the lowest out-of-pocket costs, be sure to select a Tier 1 designated provider or facility.
• UHC SignatureValue Alliance plan's Emergency Room copay is changing to $300 per visit
• The Express Scripts plans will include additional preventive medications at no cost to the member based on recommendations by the US Preventive Task Force. This applies to adults age 40-75 with a health risk factor such as hypertension or smoking, but no history of cardiovascular disease.
Chiropractic/Acupuncture(See plan summary for availability)
Provided by OptumHealth Physical Health of California providers, which has more than 2,700 network providers in California.
Three ways to find a provider:1. 1. Go to the Provider Locator search at
myoptumhealthphysicalhealthofca.com and select "Provider Locator". Choose "California Schools VEBA" from the dropdown menu for Plan/Product.
2. 2. Call Optum Member Services at 1-800-428-6337 (5 a.m. to 5 p.m., Pacific Time, Monday - Friday) for the most current and up to date information.
3. 3. Call the provider directly to schedule an appointment and verify they are part of the Optum network for VEBA.
SELECTING YOUR PLAN
Each of the available medical options covers a different network of doctors and may not offer coverage outside of that network.
1 2
California Schools VEBA | Making Health Care Better for Everyone | vebaonline.com | 1-888-276-0250
FINDING A DOCTOR OR
FACILITY
S A N M A R C O S U N I F I E D S C H O O L D I S T R I C T : C e r t i f i c a t e d / M a n a g e m e n t
VEBA Advocacy: When your doctor or health plan can’t help you, call VEBA’s Advocacy Office.
They’ll help you resolve benefit issues.
Employee Assistance Program: Get through life’s challenges with counseling, budgeting, and legal advice, child and eldercare support,
and more.
Best Doctors: Started by Harvard doctors, Best Doctors gives you access to medical experts to make sure you have the right diagnosis and treatment for your situation at no cost to you.
CONTACTS
UHC members get their Rx benefits through Express Scripts. Your copay and coinsurance amounts are based on where you fill your prescriptions. Non-EAN pharmacies will charge an additional $5 copay per prescription. For the lowest copays, be sure to
utilize an Express Scripts Advantage Network (EAN) pharmacy.
If you continue to use a retail pharmacy after 3 fills of your medication, then you will pay the maintenance copay for a 30-day supply.
EXPRESS
SCRIPTS
California Schools VEBA | Making Health Care Better for Everyone | vebaonline.com | 1-888-276-0250
ADDITIONAL
VEBA SERVICES
Short-Term Drugs (up to a 30-day supply)Use Express Scripts Advantage Network (EAN) pharmacy (for lowest cost) or non - EAN pharmacy
Maintenance Drugs (up to a 90-day supply)Use Express scripts Smart90 pharmacy or Express Scripts Home Delivery for lowest cost
• Costco• VONS• Ralphs
• Haggen• Rite Aid• Kmart• Many Independent
Pharmacies
• Walgreens• CVS• Target• Many Independent Pharmacies
• Costco• Rite Aid
• Express Scripts
Smart90 Pharmacies
Home Delivery
EAN Pharmacies
Non-EAN Pharmacies
Benefit
Best Doctors
Employee Assistance Program
Express Scripts
Kaiser
Optum Health (Chiropractic/Acupuncture)
UnitedHealthcare (UHC)
Website
Bestdoctors.com
LiveandWorkWell.comAccess: VEBA
Express-Scripts.com
KP.org
MyOptumHealthPhysicalHealthofCA.com
MyUHC.com
Phone
866-904-0910
888-625-4809
800-918-8011
800-464-4000
800-428-6337
888-586-6365
* Brand Deductible Applies: $250/Individual and $500/family1 UHC members pay standard copays plus $5/prescription at a non-EAN pharmacy (non-EAN pharmacies include CVS, Target, Walgreens, and certain independent pharmacies)2 UHC members pay the Retail Refill Allowance (RRA) penalty (equal to 2 times short-term medication copay for 30-day supply) if you fill maintenance prescriptions at a network pharmacy other than Smart90.3 Services must be medically necessary and may be subject to prior authorization from OptumHealth
Disclaimer: This summary is merely a brief description of the major benefits of the plan(s) and is not intended to alter or expand benefits, right, or liabilities as set forth in the official plan documents and contracts. Limitations may apply. See the Certificate/Evidence of Coverage for details.
1 In Texas, Delta Dental Insurance Company offers a Dental Provider Organization (DPO) plan.
2 You can still visit any licensed dentist, but your out-of-pocket costs may be higher if you choose a non-PPO dentist. Network dentists are paid contracted fees.
3 You are responsible for any applicable deductibles, coinsurance, amounts over plan maximums and charges for non-covered services.
4 We recommend verifying before each appointment that your dentist is a PPO dentist.
5 Applies only to procedures covered under your plan. If you began treatment prior to your effective date of coverage, you or your prior carrier is responsible for any costs. Group- and state-specific exceptions may apply. Enrollees currently undergoing active orthodontic treatment may be eligible to continue treatment under Delta Dental PPO. Review your Evidence of Coverage, Summary Plan Description or Group Dental Service Contract for specific details about your plan.
LEGAL NOTICES: Access federal and state legal notices related to your plan at deltadentalins.com/about/legal/index-enrollee.html.
Save with PPOVisit a dentist in the PPO1 network to maximize your savings.2 These dentists have agreed to reduced fees, and you won’t get charged more than your expected share of the bill.3 Find a PPO dentist at deltadentalins.com.4
Set up an online accountGet information about your plan anytime, anywhere by signing up for an Online Services account at deltadentalins.com. This free service, available once your coverage kicks in, lets you check benefits and eligibility information, find a network dentist and more.
Check in without an ID cardYou don’t need a Delta Dental ID card when you visit the dentist. Just provide your name, birth date and enrollee ID or social security number. If your family members are covered under your
plan, they will need your information. Prefer to take a paper or electronic ID card with you? Simply sign in to Online Services, where you can view or print your card with the click of a button.
Coordinate dual coverage If you’re covered under two plans, ask your dental office to include information about both plans with your claim, and we’ll handle the rest.
Understand transition of careDid you start on a dental treatment plan before your PPO coverage kicked in? Generally, multi-stage procedures are only covered under your current plan if treatment began after your plan’s effective date of coverage.5 You can find this date by logging in to Online Services.
Newly covered?Visit deltadentalins.com/welcome.
Save with a PPO dentist
PPO NON–PPO
Keep Smiling Delta Dental PPOSM
Eligibility Primary enrollee, spouse and eligible dependent children to age 19 or to age 25 if dependent is full-time student
Maximums $1,750 per person each calendar year
Waiting Period(s) Basic Svcs. None
Major Svcs. None
Prosthodontics None
Orthodontics None
* Limitations or waiting periods may apply for some benefits; some services may be excluded from your plan.Reimbursement is based on Delta Dental maximum contract allowances and not necessarily each dentist’ssubmitted fees.
** Reimbursement is based on PPO contracted fees for PPO dentists, PPO contracted fees for Premier dentists and PPO contracted fees for non-Delta Dental dentists.
Delta Dental of California 100 First St. San Francisco, CA 94105
Customer Service 866-499-3001
Claims Address P.O. Box 997330 Sacramento, CA 95899-7330
deltadentalins.com This benefit information is not intended or designed to replace or serve as the plan’s Evidence of Coverage or Summary Plan Description. If you have specific questions regarding the benefits, limitations or exclusions for your plan, please consult your company’s benefits representative.
HLT_PPO_2COL_DDC (Rev. 10/16) CA-MX
Plan Benefit Highlights for: San Marcos Unified School District (Active & COBRA) Group No: 07128 - 07777 & 07778
Benefits and Covered Services*
Delta Dental PPO dentists**
Non-Delta Dental PPO dentists**
Diagnostic & Preventive Services (D & P)
Exams, two cleanings, x-rays, sealants
100 % 100 %
Basic Services Fillings, simple tooth extractions
100 % 100 %
Endodontics (root canals)Covered Under Basic Services
100 % 100 %
Periodontics (gum treatment)Covered Under Basic Services 100 % 100 %
Oral Surgery Covered Under Basic Services
100 % 100 %
Major Services Crowns, inlays, onlays and cast restorations
100 % 100 %
Prosthodontics Bridges, dentures and implants
50 % 50 %
Orthodontic Benefits Dependent children to age 19 only
Dental Accident Benefits 100 % (separate $1,000 maximum per
person each calendar year)
100 % (separate $1,000 maximum per
person each calendar year) Temporomandibular Joint (TMJ) Benefits
70 % ($300 lifetime maximum
per person)
70 % ($300 lifetime maximum
per person)
Get the best in eyecare and eyewearwith San Marcos Unified School Districtand VSP® Vision Care.At VSP, we invest in the things you value most—the best careat the lowest out-of-pocket costs. Because we’re the onlynational not-for-profit vision care company, you can trust thatwe’ll always put your wellness first.
You’ll like what you see with VSP.Value and Savings. You’ll enjoy more value and the lowest out-of-pocketcosts.
High Quality Vision Care. You’ll get the best care from a VSP provider,including a WellVision Exam®—the most comprehensive exam designedto detect eye and health conditions. Plus, when you see a VSP provider,your satisfaction is guaranteed.
Choice of Providers. The decision is yours to make—choose a VSPprovider or any out-of-network provider.
Great Eyewear. It’s easy to find the perfect frame at a price that fits yourbudget.
Using your VSP benefit is easy.Register at vsp.com Once your plan is effective, review your benefitinformation.
Find an eyecare provider who’s right for you. To find a VSP provider,visit vsp.com or call 800.877.7195.
At your appointment, tell them you have VSP. There’s no ID cardnecessary. If you’d like a card as a reference, you can print one onvsp.com.
That’s it! We’ll handle the rest—there are no claim forms to complete whenyou see a VSP provider.
Choice in EyewearFrom classic styles to the latest designer frames, you’ll find hundreds ofoptions. Choose from featured frame brands like Anne Klein, bebe®, CalvinKlein, Flexon®, Lacoste, Nike, Nine West, and more1. Visit vsp.com to find aVSP provider who carries these brands.
See why we’re consumers’ #1choice in vision care2.
Every 12 months$10 for examand glassesWellVision Exam Focuses on your eyes and overall wellness
Prescription Glasses
Every 12 monthsCombined withexamFrame
$130 allowance for a wide selection of frames$150 allowance for featured frame brands20% savings on the amount over your allowance$70 Costco® frame allowance
Every 12 monthsCombined withexamLenses Single vision, lined bifocal, and lined trifocal lenses
Average savings of 20-25% on other lens enhancements
Every 12 months$0Contacts (instead ofglasses)
$130 allowance for contacts and contact lens exam (fitting andevaluation)15% savings on a contact lens exam (fitting and evaluation)
As needed$5Primary Eyecare
Treatment and diagnosis of eye conditions like pink eye, vision lossand monitoring of cataracts, glaucoma and diabetic retinopathy.Limitations and coordination with medical coverage may apply. Askyour VSP doctor for details.
Glasses and Sunglasses
Extra Savings
Extra $20 to spend on featured frame brands. Go to vsp.com/specialoffers for details.20% savings on additional glasses and sunglasses, including lens enhancements, from any VSP provider within 12months of your last WellVision Exam.
Retinal ScreeningNo more than a $39 copay on routine retinal screening as an enhancement to a WellVision Exam
Laser Vision CorrectionAverage 15% off the regular price or 5% off the promotional price; discounts only available from contracted facilities
Your Coverage with Out-of-Network Providers
Visit vsp.com for details, if you plan to see a provider other than a VSP network provider.
Exam .............................................................................. up to $40Frame ............................................................................ up to $45Single Vision Lenses ........................................... up to $40
Lined Bifocal Lenses .......................................... up to $60Lined Trifocal Lenses ......................................... up to $80
Progressive Lenses ............................................. up to $80Contacts .................................................................... up to $105
VSP guarantees coverage from VSP network providers only. Coverage information is subject to change. In the event of a conflict between this information and your organization’s contract with VSP,the terms of the contract will prevail. Based on applicable laws, benefits may vary by location.
Contact us. 800.877.7195 | vsp.com1Brands/Promotion subject to change.
2Blueocean Market Intelligence National Vision Plan Member Research, 2014
