Vision Benefits

STANDARD EYE EXAMINATION AND GLASSES
Eye Examination:	Once each 12 months*
Spectacle Lenses:	Once each 12 months*
Frames:	Once each 24 months*
* from your last date of service
Subject to a co-payment of twenty dollars ($20.00). See Step Three on page 35.

SPECTACLE LENSES AND FRAME: Vision Service Plan covers a wide selection of frames, but not all frames will be covered in full. When a patient selects a frame that exceeds the Plan’s allowance, these additional charges are administered at VSP’s controlled costs. VSP also has controlled costs for cosmetic options, and these charges are typically less than usual and customary fees. Please consult your participating doctor about lens options which may be cosmetic in nature, and may result in additional costs. VSP offers you even more value by providing you with a 20% discount on a second pair of prescription glasses.

CONTACT LENSES: Elective or medically necessary contact lenses may be provided instead of glasses.

-Elective contact lenses: The standard eye examination is covered in full, less a $20.00 co-payment. An allowance will be provided toward the contact lens evaluation examination, fitting costs, and materials. Any costs exceeding the allowance are the patient’s responsibility. Contact lens frequency is the same as for spectacle lenses (eyeglasses). Under this plan, if you elect contact lenses, you will be eligible for a frame 24 months after the last date of obtaining the contact lenses. VSP’s additional value is also extended to include a 15% discount off the participating doctor’s professional services when you purchase prescription contact lenses. Materials are provided at usual and customary fees. This benefit is available in conjunction with your VSP contact lens allowance, or you can use it to purchase contacts in addition to glasses. You may use these discounts for 12 months following the date of the covered eye examination. Also, these discounts are only offered through the VSP participating doctor who provided the last covered eye examination.

-Medically necessary contact lenses: Covered in full when prescribed by a participating doctor for one of the following conditions: following cataract surgery; to correct extreme vision problems that cannot be corrected with spectacle lenses; with certain conditions of anisometropia; or with certain conditions of keratoconus. The participating doctor must secure prior approval from VSP for medically necessary contact lenses.

Obtaining Benefits

STEP ONE: When you are ready to obtain vision care services, call your VSP participating doctor. If you need to locate a VSP participating doctor, call Vision Service Plan at (800) 877-7195 (T.D.D. for the hearing impaired 1-800- 428-4833) or visit their World Wide Web site at www.vsp.com.

STEP TWO: When making an appointment, identify yourself as a VSP member. The participating doctor will also need the covered member’s identification number (usually the social security number), and the covered member’s group name which is the Bay Area Roofers Health and Welfare Plan. The participating doctor will contact VSP to verify your eligibility and plan coverage. The articipating doctor will also obtain authorization for services and materials. If you are not eligible, the VSP doctor will notify you.

STEP THREE: At your appointment, the participating doctor will provide an eye examination and determine if eyewear is necessary. If so, the participating doctor will coordinate the prescription with a VSP approved, contract laboratory. The participating doctor will itemize any non-covered charges and have you sign a form to document that you received services. VSP will pay the participating doctor directly for covered services and materials. You are responsible for paying the doctor a $20.00 co-payment, and any additional costs resulting from cosmetic options, or non-covered services and materials you have selected. Selecting a participating doctor from VSP’s network assures direct payment to the doctor and guarantees quality services and materials.

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