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Benefits

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Vision Plan - Florida

Contact

VSP (Vision Service Provider)
Group Number: 30015877
(800) 877-7195
www.vsp.com

Information

Employees and their dependents covered under any of the medical plans are eligible for vision coverage administered by VSP. Participants and their dependents should go to a vision provider in the VSP network for maximum vision benefits. To access the VSP provider network, go to www.vsp.com. A Participating VSP Provider will file claims directly with VSP.

The Vision Plan provides coverage for the following services, less a $10 co-payment for lenses OR exams. No more than one $10 co-payment will be charged every 12 consecutive months.

Schedule of Allowances

Benefits Maximum
Comprehensive One exam every 12 consecutive months
Standard Lenses. (Standard lenses fit any frame with an eye size less than 61 mm. You must pay the difference in cost for any upgrades. Upgrades such as polycarbonates, progressive bi-focals, scratch-coating, tints and over-sized lenses are not covered). One pair every 12 consecutive months
Standard Frames (standard frames are covered up to a maximum retail cost of $150 or less. You must pay the difference in cost over the $150 retail allowance). One frame every 24 consecutive months
Contact Lenses (in lieu of lenses and frames) $150 every 12 consecutive months. The plan allows one contact lenses fitting fee every 12 consecutive months up to a $40 limit (this is in addition to the $150 allowed for contact lenses). Note: Any balance is your responsibility. If you spend less than the $150 allowance, the unused portion will not be credited toward future purchases.
Contact Lenses (Medically Necessary) Benefits would be covered in full following cataract surgery or when visual acuity cannot be corrected 20/70 in the better eye except through the use of contacts; or when necessitated by anisometropia or keratoconus. Prior authorization from the Claims Administrator is required.
additional links

FAQs (Frequently Asked Questions)

Summary Plan Descriptions

www.vsp.com

Forms

No claim form is necessary for the vision plan when using a VSP provider. If you paid out-of-pocket for vision services, contact VSP at: (800) 877-7195 for information on how to file for reimbursement.