CODAC 2024 Guide To Your Benefits

FIND A PROVIDER

VISION PLAN

To find a VSP provider in your area, visit the website at www.vsp.com.

The VSP vision plan offers coverage both in-network and out-of-network. It is to your advantage to utilize an in-network provider in order to achieve the greatest cost savings. If you go out-of-network, your benefit is based on a reimbursement schedule. In addition, if you are considering Lasik surgery or other non-covered benefits, there are discounts available with some providers.

● Click on “Find a Doctor” ● Search by Location, Office, or Doctor ● Enter Criteria and click “Search”

Click here to learn more about your vision benefits with VSP

VSP CHOICE

In Network

Base Plan

Buy - up Plan

Vision Examination

$10 copay

$10 copay

Retinal Screening

$0 copay

$0 copay

Examination Frequency

Every 12 months

Every 12 months

$20 copay - Additional exams/services beyond routine care to treat immediate issues

$20 copay - Additional exams/services beyond routine care to treat immediate issues

Essential Medical Eye Care

Prescription Glasses

$25 copay

$25 copay

Lens Options: Single, Bifocal, Trifocal Standard Progressive Premium Progressive Custom Progressive

Included in Prescription Glasses copay $0 copay

Included in Prescription Glasses copay $0 copay

$95 - $105 copay $150 - $175 copay

$40 copay $40 copay

Lens Enhancement Options

Average savings of 30%

Average savings of 30%

Lens Frequency

Every 12 months

Every 12 months

Included in Prescription Glasses copay $180 allowance $200 featured frame allowance $100 Walmart/Sam ’ s Club/Costco allowance 20% savings on amount over allowance

Included in Prescription Glasses copay $250 allowance $270 featured frame allowance $135 Walmart/Sam ’ s Club/Costco allowance 20% savings on amount over allowance

Frames

Frames Frequency

Every 24 months

Every 12 months

Elective: $160 allowance for contacts & exam (eval & fitting) Medically necessary: Covered in full

Elective: $230 allowance for contacts & exam (eval & fitting) Medically necessary: Covered in full

Contact Lenses (in lieu of glasses)

Contact Lens Frequency

Every 12 months

Every 12 months

$180 allowance for ready - made non - prescription sunglasses or ready - made non - prescription blue light filtering glasses

$250 allowance for ready - made non - prescription sunglasses or ready - made non - prescription blue light filtering glasses

Lightcare (in lieu of glasses)

Frames Frequency

Every 24 months

Every 12 months

Laser Vision Correction

15% off retail price or 5% off promotional price

15% off retail price or 5% off promotional price

Network

VSP Choice

VSP Choice

Base Plan

Buy - Up Plan

RATES

Employee Per Month

Employee Per Paycheck

Employee Per Month

Employee Per Paycheck

Employee Only

$6.30

$2.91

$10.05

$4.64

Employee + Spouse

$12.60

$5.82

$20.08

$9.27

Employee + Children

$13.47

$6.22

$21.53

$9.94

Employee + Family

$21.53

$9.94

$34.19

$15.78

Affiliate/Costco Program: The member’s benefit experience with an affiliate or Costco provider is the same as going to a VSP Preferred Provider. Affiliate/Costco providers can provide a covered-in-full benefit experience. Please see their website at www.vsp.com . Dependents are eligible to age 26.

10 CODAC Health, Recovery & Wellness | 2024 Employee Benefits Guide