Vision

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.

Although vision care services and supplies are covered in-network and out-of-network, your benefits are generally greater when you use in-network providers. Your costs are based on the family members you choose to cover.

Vision Choice

Plan Information

Plan Name: Vision PPO Plan

Policy Number: 30076094

Effective Date: 07/01/2025

Provider Network: VSP Choice

Benefit Highlights

In-Network Only

Exams
$25

Single Vision Lenses
Combined with exam

Bifocal Lenses
Combined with exam 

Trifocal Lenses
Combined with exam 

Frames
Combined with exam; $200 frame allowance

Contacts (in lieu of glasses)
$130 allowance; Fitting and Evaluation: up to $60

Frequency

Exams
Once every 12 months

Lenses
Once every 12 months

Frames
Once every 24 months

Contacts
Once every 12 months

Contact Information