Vision Care Benefits       Email   Print

Applies to All CHP Options
Not Applicable for Medicare Members
 
Administered by Vision Service Plan: 800-877-7195
Contact Vision Service Plan toll-free: 800-877-7195

2010 Benefits

In-Network Benefit Amounts:

Non-Network Reimbursement Amounts:

Eye Exam (one exam every 12 months)

 100%, after $10 copay Up to $45
Prescription Glasses (lenses covered every 12 months) 

Single vision

 100%, after $25 copay Up to $45

Bifocal lenses, including Progressive lenses (no lines)

 100%, after $25 copay Up to $65

Trifocal lenses including Progressive lenses (no lines)

 100%, after $25 copay Up to $85

Frame (covered every 24 months)

 Up to $120 every two years, plus 20% off any out-of-pocket costs Up to $47
Contact Lenses (covered every 12 months)   

Elective Contact Lenses

 $120 allowance applied to the cost of contact lenses and exam (fitting and evaluation). Up to $105

Medically Necessary Contact Lenses

 Covered in full Up to $210
All services and related products must be received or purchased through Vision Service Plan. Note: Glasses and contact lenses will not both be covered by the plan in the same 12-month period. At least 12 months must separate the purchase of glasses and contact lenses in order for coverage to be provided for both.


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