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EMPLOYERS - VISION PLANS

BENEFITS AT A GLANCE
VSP Benefits are designed to protect your visual wellness. Consequently, you may have to pay extra if you choose certain cosmetic or elective eyewear options. Before selecting your eyewear, ask your doctor what is fully covered by your VSP plan. The following summarizes the main benefits covered by your plan.
 
Exam Plus
BenefitsCo-Pay
Examination every 24 months*$10.00
Lenses & Frames2,*20% discount
Contact Lens Service3,*15% discount
 

* Based on your last date of service.

1 Discount applied to VSP Doctor's usual and customary fees for complete pairs of prescription glasses and spectacle lens option.

2 Discount applies to VSP Doctor's professional services associated with all prescription contact lenses (materials at Doctor's usual costomary fees).

3 Discounts will apply anytime during the 12 month period following the covered examination through the VSP member doctor who last provided the eye examination. Discounts only offered through the VSP provider network.

 
Eye Examinations
Comprehensive eye examination covered in full through VSP's national network of participating doctors.

Glasses
20 percent discount applied to VSP participating doctors usual and customary fees for complete pairs of prescription glasses with any spectacle lens option.

Contact Lenses
15 percent discount on VSP participating doctor's professional services associated with all prescription contact lens (materials at doctor's usual and customary fees).

PLANS - SUMMARY OF BENEFITS
 
PLAN 1 - Summary of Benefits
 
Frequency
Copayment
Examination
12 months*
$10.00
Materials
24 months*
$25.00
 
PLAN 2 - Summary of Benefits
 
Frequency
Copayment
Examination
12 months*
$10.00
Materials
24 months*
$25.00
 
PLAN 3 - Summary of Benefits
 
Frequency
Copayment
Examination
12 months*
$10.00
Materials
24 months*
$25.00
 
 
Participating Provider1
Non-Participating Provider (Reimbursement up to)1
Examination
Paid In Full
$25.00
Materials
Basic Lenses
Single Vision
Paid In Full
$30.00
Bifocal
Paid In Full
$30.00
Trifocal
Paid In Full
$30.00
Lenticular
Paid In Full
$30.00
 
Frames1
Wide Sel. of frames is covered in full
$45.00
 
Contacts 2,4
(in lieu of lenses and frames)
 
 
Medically Necessary6
Paid In Full
$210.00
 
Elective
Allowance of $105.00
$105.00

* Based on your last date of service.

2 Subject to Copayments. Your Copayments apply to in and out of network Benefits.

3 The VSP program covers a wide selection of quality frames. Because of the cosmetic nature of frames and rapidly changing style, VSP has a limit on the cost of frames provided under the program. The limit is designed to cover the majority of frames currently in use. Members who select frames that exceed the limit will pay extra. The Member can find out from their VSP doctor, when they are looking at frames, which ones will be within their VSP allowance. Your plan also provides a 20% discount on additional complete pairs of prescription glasses.

4 Members can choose contacts in lieu of spectacle lenses and a frame.

5 Your plan includes a 15% discount off of the VSP doctors professional services when buying contact lenses. Materials are provided at the customary fees.

6 Medically necessary contact lenses must be prescribed by a VSP doctor for certain conditions. Your VSP doctor must get prior approval from VSP for medically necessary contact lenses.

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Concert Health Plan
2605 W 22nd St. Suite 25
Oak Brook, Illinois 60523
Phone: (630) 990-1090 · Fax: (630) 990-1092
Customer Service: (866) 818-3106
www.concerthealth.com
Email: info@concerthealth.com

© Concert Health Plan - 2000