Group Vision – VSP 1 – Dental Select

` Group Vision – VSP 1 – Dental Select

VSP 1

Covers an average cost for contacts with no member cost. New frames available every other year from retailers including Costco, Walmart, & Sam’s Club.

Getting a quote is easy, simply send the required information to one of our underwriting specialists at quotes@dentalselect.com

Plan Summary

In-Network

Out-of-Network

Wellvision Exam

In-Network

$10 Deductible

Out-of-Network

$45 Allowance

Contact Lens Exam (fitting and evaluation)

In-Network

$60 Deductible

Out-of-Network

N/A

Frames

In-Network

$25 Deductible

Out-of-Network

$70 Allowance

In-Network

$130 Frame allowance

Out-of-Network

In-Network

$150 Featured frame brands allowance†

Out-of-Network

In-Network

$70 Costco/Walmart/Sam's Club frame allowance

Out-of-Network

Single Vision Lenses

In-Network

Covered in full*

Out-of-Network

$30 Allowance

Bifocal Lenses

In-Network

Covered in full*

Out-of-Network

$30 Allowance

Trifocal Lenses

In-Network

Covered in full*

Out-of-Network

$30 Allowance

Standard Progressive Lenses

In-Network

$0 Deductible: Covered in full*

Out-of-Network

N/A

UV Protection

In-Network

Single Vision-$10 / Multi-Focal-$10

Out-of-Network

N/A

Tint (Solid & Gradient)

In-Network

Single Vision-$15 / Multi-Focal-$15

Out-of-Network

N/A

Standard Scratch-Resistant Coating

In-Network

Single Vision-$17 / Multi-Focal-$17

Out-of-Network

N/A

Standard Impact Resistant Lenses (Polycarbonate For Adults)

In-Network

Single Vision-$31 / Multi-Focal-$35

Out-of-Network

N/A

Standard Anti-Glare Coating

In-Network

Single Vision-$41 / Multi-Focal-$41

Out-of-Network

N/A

Premium Progressive Lenses

In-Network

Single Vision-N/A / Multi-Focal-$95-$105

Out-of-Network

N/A

Custom Progressive Lenses

In-Network

Single Vision-N/A / Multi-Focal-$150-$175

Out-of-Network

N/A

Other Add-ons & Services

Based on applicable laws, reduced costs may vary by doctor location.

In-Network

Average savings of 30% on other lens enhancements

Out-of-Network

Conventional Contact Lenses

In-Network

$130 Allowance

Out-of-Network

$105 Allowance

Disposable Contact Lenses

In-Network

$130 Allowance

Out-of-Network

$105 Allowance

Medically Necessary Contact Lenses

In-Network

$0 Deductible: Covered in full

Out-of-Network

$210 Allowance

Exam

In-Network

Once every 12 months

Out-of-Network

Once every 12 months

Frames

In-Network

Once every 24 months

Out-of-Network

Once every 24 months

Lenses

In-Network

Once every 12 months

Out-of-Network

Once every 12 months

LASIK or PRK Vision Correction

Based on applicable laws, reduced costs may vary by doctor location.

In-Network

Average 15% off regular price or 5% off promotional price; discounts only available from contracted facilities.

Out-of-Network

Not covered

FAQ

Which Networks can members use with this plan?

When will this plan be effective?

Who can subscribers include on a plan?

When can members start using benefits?

Is LASIK or PRK covered?

How will members submit a claim?

Where can I find a copy of the plan comparison?

Who can change eligibility information?

How long is the time period to enroll?

When can members change or cancel a plan, including adding or deleting dependents?

Can our group offer both a VSP and EyeMed plan?

Legal

*Included in materials copay.

†Only available to VSP members with applicable plan benefits. Frame brands and promotions are subject to change. Savings based on doctor’s retail price and vary by plan and purchase selection; average savings determined after benefits are applied. Ask your VSP network doctor for more details.

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VSP is a registered trademark of Vision Service Plan. All other brands or marks are the property of their respective owners.