Vision Plan

Sample Company offers vision coverage through VSP to save you money on expenses such as eye exams, glasses, and contact lenses.

Healthy eyes and clear vision are an important part of your overall health and quality of life. You may enroll yourself and your eligible dependents or you may waive vision coverage. You do not have to be enrolled in medical coverage to elect vision coverage or cover the same dependents under medical and vision.

Key Features

  • Affordable coverage that helps you manage the cost of vision care and supplies —  see your contribution rates
  • Eye exam covered every year, with only a small copay charged to you
  • Coverage for prescription eyeglasses or contact lenses so you can choose the method of correction you prefer
  • Freedom to see any vision provider you want; however, you will get the best value from your plan benefits when you receive care from a VSP network provider

Choice of four coverage levels:

  • Employee Only
  • Employee + Spouse/Domestic Partner
  • Employee + Child(ren)
  • Employee + Family

Find a Network Provider

You’ll get the best value by using a provider in the VSP network.

Plan Comparison

The table below summarizes the key features of the vision plan. Please refer to the official plan documents for additional information on coverage and exclusions.

Plan Details In-Network Out-of-Network
WellVision Eye Exam
(every 12 months)
$10 copay Reimbursed up to $45
Prescription Glasses $25 materials copay for frame and lenses combined (lens enhancements have separate copays) See frames, lenses, and lens enhancements
(every 12 months)
$120 allowance for a wide selection of frames
$140 allowance for featured frame brands
20% savings on the amount over your allowance
$65 Costco® frame allowance
Reimbursed up to $70
(every 12 months)
Single vision, lined bifocal, and lined trifocal lenses
Polycarbonate lenses for dependent children
Photochromic/tints/dyes for dependent children covered in full
Single vision: Reimbursed up to $30
Lined bifocal: Reimbursed up to $50
Lined trifocal: Reimbursed up to $65
Lens Enhancements
(every 12 months)
Standard progressive: $0 copay
Premium progressive: $95 – $105 copay
Custom progressive: $150 – $175 copay
Average savings of 20% – 25% on other lens enhancements
Progressive: Reimbursed up to $50
Contact Lenses
(instead of glasses)
(every 12 months)
Contact lens exam (fitting and evaluation): up to $60 copay
$120 allowance for contacts; copay does not apply
Reimbursed up to $105
Diabetic Eyecare Plus Program $20 copay for services related to diabetic eye disease, glaucoma, and age-related macular degeneration (AMD); retinal screening for eligible members with diabetes. Limitations and coordination with medical coverage may apply. Ask your VSP doctor for details. N/A
Extra Savings
Glasses and Sunglasses Extra $20 to spend on featured frame brands (see for details)
20% savings on additional glasses and sunglasses, including lens enhancements from any VSP provider within 12 months of your WellVision exam
Retinal Screening No more than a $39 copay on routine retinal screening as an enhancement to a WellVision exam N/A
Laser Vision Correction Average 15% off regular price or 5% off promotional price; discounts only available from contracted facilities N/A