Vision Plan - Vision Service Plan (VSP)

October 1, 2002 - September 30, 2003

MEDICAL         DENTAL         VISION         LIFE/AD&D         LTD         STD         FLEX         EAP

Information provided is in summary format.  Any difference between the summary provided and actual contract will be settled in favor of the contract.
	In-Network	Out-Of-Network
Vision Network:	VSP Participating Providers	Non-Participating Providers
Deductible	$10 for exam, $25 for materials
Vision Exam:
Time Limit	One every 12 months
Payment Limit	$10 Co-pay	Up to $40 reimbursement
Frames:
Time Limit	One pair every 24 months
Payment Limit	$25 Co-pay	Up to $30 reimbursement
Lenses:
Time Limit	One pair every 12 months
Payment Limits:
Single	$25 Co-pay	$32
Bifocal	$25 Co-pay	$52
Trifocal	$25 Co-pay	$72
Lenticular	$25 Co-pay	$160
Necessary Contact Lenses:
Time Limit	One pair every 12 months
Payment Limit	$25 Co-pay	$200
Elective Contact Lenses:
Time Limit	One pair every 12 months
Payment Limit	$105	$82
Check Your Vision Benefits	Find information here on the current status of your vision benefits, such as how much is available for vision hardware purchases and when your next exam will be covered.

 *When you receive services from a VSP participating doctor or optometrist your only expense is for the co-payment and charges for any services or materials not covered by this section or for costs above the maximum allowances for materials.

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