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 |