The County of Monterey VSP WellVision Coverage At a Glance (Effective January 1, 2003)

Benefit

Frequency

(Based on service year)

Copayment

 

Coverage from

a VSP doctor

Out-of-Network

Reimbursement

Eye Care Wellness Ė Regular exams are essential for protecting your visual wellness.

Exam

 

12 months

$ 10.00

Covered in full.

Up to $40.00 allowance

Prescription Eyewear Ė You may choose between glasses or contacts. Remember if you choose contacts, you will not be eligible to receive glasses (lenses and frame) in the same service period.

Lenses

 

12 months

$25.00

(applied to lenses & frame)

Single vision, lined bifocal and lined trifocal lenses are covered in full. 1

Single vision up to

$40.00 allowance

Lined bifocal up to

$60.00 allowance

Lined trifocal up to

$80.00 allowance

Frame

 

24 months

 

Covered up to $115.00 allowance2

Up to $45.00 allowance

Contact Lenses

 

12 months

None

Covered up to $105.00 allowance

Up to $105.00 allowance

Your allowance applies to the cost of your contact lens exam and your contact lenses. Youíll receive a 15 percent savings off the cost of your contact lens exam from a VSP doctor. Your contact lens exam is performed in addition to your routine eye exam to check for eye health risks associated with improper wearing or fitting of contacts.

Supplemental Coverage ó VDT Glasses

VDT Glasses - This enhancement allows employees only to obtain VDT glasses (lenses and a frame prescribed for use when viewing a computer monitor), in addition to those received under the core plan. Prescription lenses, available every 12 months, covered in full when obtained from a VSP doctor.Frames, available every 24 months, following a $20.00 copay.

Value Added Discounts

Laser VisionCareSM - VSP has contracted with many of the nationís finest laser surgery facilities and doctors, offering you a discount off PRK and LASIK surgeries, available through contracted laser centers. Visit VSPís Web site at www.vsp.com to learn more about this exciting program.

Contact Lenses Ė VSP also offers valuable savings on annual supplies of certain brands of contacts. You can receive these VSP member preferred prices, even if you use your coverage for glasses. Visit vsp.com or ask your doctor for details.

Prescription Glasses Ė Receive 20 percent savings when you purchase non-covered pairs of prescription glasses, including prescription sunglasses from the same VSP doctor within 12 months of your last eye exam.

1         Lens options, which can enhance the appearance, durability and function of your glasses, are available to you at VSPís member preferred pricing. Ask your doctor for details.

2         If you choose a frame valued at more than your allowance, youíll save 20 percent on your out-of-pocket costs for frames.

Locating Your VSP Doctor:When you obtain services from a VSP doctor, you get the most value from your VSP benefit. VSP offers two convenient ways to locate a VSP doctor near your home or office, or to verify your doctor is a VSP doctor:

          Visit us at www.vsp.com

          Call Member Services at (800) 877-7195

Using Your VSP Benefit:No cards, no claim forms, no hassles. To access your benefits, simply:

          Make an appointment with a VSP doctor

          Tell the doctor you are a VSP member when making the appointment

          Provide the doctor with the covered memberís ID

Out-of-Network Providers

Although more than 90 percent of VSP members receive care from VSP doctors, you have the option of seeing an out-of-network provider. If you see an out-of-network provider, be aware your out-of-network benefits do not guarantee full payment. For out-of-network reimbursement, pay the entire bill when you receive services, then send your itemized receipt to VSP within six months from your date of service. Included with your receipt should be the covered memberís name, phone number, address, member ID, the name of the group, the patientís name, date of birth, phone number and address, and the patientís relationship to the covered member (such as spouse, child, etc.).

Please keep a copy of the information for your records and send the originals to the following address:
VSP,
P.O. Box 997105, Sacramento, CA 95899-7105.