Banner
Banner





Vision Benefits
Applies to All CHP Options

 
Administered by Vision Service Plan: 800-877-7195
Contact Vision Service Plan toll-free: 800-877-7195
 
 
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
  • Lined bifocal
 100% after $25 copay Up to $65
  • Lined trifocal
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.

 

Vision Benefits—Additional Discounts & Savings

 
In-Network Benefit Amounts:
Non-Network Reimbursement Amounts:
Additional complete set of prescription glasses or sunglasses
(available from the same VSP doctor who provided eye exam within last 12 months)		 20% discount Not covered
Lens extras, such as scratch resistant and anti-reflective coatings and progressives 20% discount Not covered

Contact lenses exam (fitting and evaluation)

15% discount

 Not covered

Laser Vision Correction

 Discount varies – call VSP for more information or visit their Web site Not covered

Items Not Covered:

  • Non-prescription (plano) lenses
  • Two pairs of glasses instead of bifocals
  • Replacement/repair of lost/broken lenses or frames
  • Medical or surgical treatment
  • Services/materials covered under worker’s compensation
  • Eye exams required as a condition of employment

 
©Copyright 2007 Concordia Plan Services of The Lutheran Church—Missouri Synod. All rights reserved.
Disclaimer Notice