Vision Benefits

Benefit Description

This benefit is available if You are covered under the Self-Funded Medical Indemnity PPO Plan, the Kaiser Permanente Plan. The vision benefits are provided through a contract with Vision Service Plan (VSP).

Benefit Summary

When Using A VSP Doctor
Exam (every 12 months) $10 copay adults; no charge for children under age 19
Prescription Glasses $25 copay adults; no charge for children under age 19
Frame (every 12 months) $150 frame allowance; $170 featured frames; 20% savings over allowance
Lenses (every 12 months) Glass or plastic, single vision, lined bifocal and lined trifocal included in prescription
Lens Enhancements (every 12 months) Impact-resistant lens, scratch-resistant and UV coating, progressives – see discount schedule in Vision Program Updates
Contact Lenses (instead of glasses, every 12 months)

$150 allowance

For information about contact lens exams and medically necessary contacts, see Vision Program Updates

Diabetic Eyecare Plus Program See Vision Program Updates
Out Of Network Reimbursements
Exam $50
Single vision lenses $50
Lined bifocal lenses $75
Lined trifocal lenses $100
Lenticular lenses $125
Progressive lenses $75
Frame $70
Contacts $105