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Vision - VSP


PLAN FEATURES
 
IN-NETWORK
 
OUT-OF-NETWORK
WellVision Exam — Every 12 months $10 Copay
$10 Copay + 
up to $45 reimbursement 
(Pay in full at time of service and submit a claim for partial reimbursement)
Prescription Lenses — Every 12 months

Single Vision
Lined Bifocal
Lined Trifocal
Lenticular

$10 Copay
Up to $45 reimbursed
Up to $65 reimbursed
Up to $85 reimbursed
Up to $125 reimbursed
Lens Enhancements — Every 12 months    
Standard Progressive
Premium Progressive
Custom Progressive
$50 Copay
$80-90 Copay
$120-160 Copay
 
Up to $85 reimbursed
Frames —
Every 12 months
Frames are covered up to an allowance of $150 ($170 for featured brands) plus 20% off amounts over your allowance.
Up to $47 reimbursed
Contact Lenses — Every 12 months
(In lieu of lenses and frames)
No Copay ($150 allowance applies to the cost of both the contacts and the exam)
Up to $105 reimbursed
Computer VisionCare
Employees are able to obtain corrective eyewear designed to meet specific health and vision needs of computer use.
Vision Exam — Every 12 months No Copay  Up to $17 reimbursed
Lenses — Every 12 months
No Copay  
(Includes Single Vision, Lined Bifocal, Lined Trifocal, and Lenticular lenses)
From $55 to $125 reimbursed
(Based on lens type)
Frames — 
Every 12 months
Frames are covered up to an allowance of $90 ($110 for featured brands) plus 20% off amounts over your allowance.  

Up to $35 reimbursed
Primary Eyecare
Includes diagnosis and treatment of eye conditions such as pink eye, glaucoma, cataracts and diabetic retinopathy. Limitations and coordination with medical coverage may apply. Ask your VSP provider for details.
Exams & Office Visits $20 Copay N/A
Extra Savings
Glasses/Sunglasses
30% Savings on additional glasses and sunglasses purchased on the same day as WellVision Exam
 

N/A
Retinal Screening No more than a $39 Copay
  N/A
Laser Vision Correction 5% - 15% Savings N/A

Note: Member ID Cards are not issued from VSP. When obtaining service from a participating VSP provider, the Netflix Group ID 12130543 and your Social Security Number (SSN) will serve as proof of coverage. Providing your full name, date of birth, and the last four digits of your SSN will serve as proof of coverage as well. Dependents should use the information of the Netflix employee to identify themselves to the VSP provider.