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 |
| Contact Lenses (instead of glasses, every 12 months) | $150 allowance
For information about contact lens exams and medically necessary contacts |
| Diabetic Eyecare Plus Program | See Summary Plan Description below |
| 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 |
Vision Care Documents and LInks
A full description of all benefits, including any benefits not described on this website, are found in the Summary Plan Description.
- Summary Plan Description (2023)
- Health & Welfare Workshop slides (2025)
- Health & Welfare Workshop recording (2025)
Vision Care
- VSP Website