Expatriate Vision Plan

2024 Plan Information

VSP Network Provider Eye Exam Option A

In-Network:
100% after $20 copay

Out-of-Network:
Up to $50 allowance after $20 copay

Vision Benefits

The benefits in the chart above are available once per calendar year, except for frames, which are covered once every two calendar years (under Option A, frames are covered every calendar year). Many services are covered at 100% after copay when you use in-network providers. You may also receive discounts on services at participating retail chain stores such as Cohen’s Fashion Optical, Costco and others.

VSP Option B
Note
The figures in the chart below reflect what the Plan pays, with the exception of deductibles and out-of-pocket maximums, which employees pay.
Eye Exam
In-Network: 100% after $20 copay Out-of-Network: Up to $40 allowance after $20 copay
Frames
In-Network: Up to $150 after $20 copay plus 20% discount on cost exceeding $150 every two years Out-of-Network: Up to $60 allowance after $20 copay
Lenses: Single
In-Network: 100% after $20 copay for lenses and frames Out-of-Network: Up to $40 allowance after $20 copay
Lenses: Lined Bifocal
In-Network: 100% after $20 copay for lenses and frames Out-of-Network: Up to $60 allowance after $20 copay
Lenses: Lined Trifocal
In-Network: 100% after $20 copay for lenses and frames Out-of-Network: Up to $75 allowance after $20 copay
Lenses: Progressive
In-Network: 100% after $20 copay for lenses and frames Out-of-Network: Up to $60 allowance after $20 copay
Optional Lens Types and Treatments
In-Network: 100% Out-of-Network: 5%
Elective Contact Lenses (instead of eyeglasses)
In-Network: Up to $150 and $60 max copay for contact lens exam Out-of-Network: Up to $100 (includes exam and fitting)
Medically Necessary Contact Lenses with VSP Approval
In-Network: 100% after $20 copay for exam and $20 copay for lenses once every two years Out-of-Network: Up to $210 allowance after $20 copay
Diabetic Eyecare Plus
$20 copay for additional eyecare services specifically for members with diabetic eye disease, glaucoma or age-related macular degeneration (AMD)

Notes About Lenses and Frames

The total copay for lenses generally applies to both eyeglass lenses and/or frames. You may select from a variety of optional lens types, as outlined in the Health Benefits and Insurance SPD.

Lenses are considered medically necessary for certain eye conditions that prohibit the use of glasses, including aphakia, anisometropia, high ametropia, nystagmus and keratoconus.

If you purchase frames from Costco, the frame allowance is $135 for VSP Option A and $80 for VSP Option B.

Other Vision Services

Services such as laser surgery, low vision supplemental testing, additional prescription and nonprescription glasses and sunglasses, and contact lens exams are covered to the extent described in the schedule of benefits in the Health Benefits and Insurance SPD.

Flexible Spending Account

Learn how a Health Care FSA or Limited Purpose FSA can save you 20% to 40% (depending on your tax bracket) on your health care costs, including dental expenses.

Paycheck Contributions

You pay the full cost of vision coverage. Your contributions are deducted from your pay on a before-tax basis.

	Yourself Only	Yourself + Spouse/Domestic Partner	Yourself + Children	Yourself + Family
VSP Vision Plan A Cost	$8.90	$17.80	$19.04	$30.44
VSP Vision Plan B Cost	$6.57	$13.12	$14.04	$22.43

If you are covering a domestic partner or the children of a domestic partner, the final determination of the tax status of a dependent is made by the IRS. As a result, there is no guarantee that the IRS will not impose a tax on the value of coverage. Consult your tax advisor for more information.

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