Vision Care Benefit

Vision Care Benefits are provided through a contract with an organization called VSP (Vision Service Plan). VSP gives you a choice of the way you can receive your vision care benefits.

You Can Use the VSP Doctors - VSP has arranged for a number of doctors in your area ("VSP doctors") who will provide professional vision care for you and your dependents. VSP guarantees quality and cost control. VSP doctors provide examinations, professional services, lenses, and good quality frames at no out-of-pocket expense to you. VSP pays the doctors for the services and eyewear provided to you. Any additional vision care, services and/or materials not covered by VSP can be arranged between you and the doctor, based on the wholesale cost difference and a modest service fee.
You Can Use Your Own Out-of-Network Provider - You can go to any optometrist, ophthalmologist and/ or dispensing optician for your vision care. You must pay the provider in full and then file a claim with VSP for reimbursement (see page 13). You will be reimbursed according to the Out-of-Network column on the Schedule of Benefits/Vision Care Benefits (page 11)

Covered Vision Care Services and Eyewear

The following are the vision care services and eyewear that you will receive at no cost if you use a VSP doctor. If you use an out-of-network provider, these are the services and eyewear for which VSP will reimburse you according to the Out-of-Network column on the Schedule of Benefits/Vision Care Benefits:

Vision Examination - Allowable once every calendar year. This includes a complete analysis of the eyes and related structure to determine the presence of vision problems or other abnormalities.
Frame - Allowable once every two calendar years. You can select from a wide selection of quality frames within the frame allowance.
Lenses (eyeglass) - Allowable every calendar year, if required.
Contact Lenses - If you choose contacts instead of glasses, you can get up to $100 toward the cost of the contact lenses plus the contact lens exam, evaluation and fitting.

If you use a VSP doctor, all of the covered vision care services listed above are provided at no cost to you (except items listed under the Vision Care Benefit Exclusions and Limitations section). The VSP doctor will provide the necessary eye exam, order the proper lenses if they are required, and verify the accuracy of the finished lenses. The lenses will be the finest quality American-made lenses made to exacting standards. You will have a choice of a wide selection of good quality frames. If you select lenses or a frame which costs more than the amount allowed by VSP, you pay an additional discounted charge directly to the VSP doctor.

If you use an out-of-network provider, you will be reimbursed by VSP only up to the amounts shown on the Out-of-Network column on the Schedule of Benefits/Vision Care Benefits.

Remember - This benefit is designed to cover your visual needs rather than cosmetic materials. If you select any eyewear listed in the Vision Care Benefit Exclusions and Limitations section, VSP will not reimburse any of the cost incurred from an out-of-network provider, and there will be an extra charge by a VSP doctor if he doesn't receive prior authorization from VSP to provide them.

Using a VSP Doctor

Choose the VSP doctor you want to use. You can find a VSP doctor near you by calling VSP's toll-free customer service center. If you call after hours, you will reach VSP's interactive voice response system. You can use this system to find out if a doctor you want to use is a VSP doctor. You can also go to www.vsp.com on the internet and click on Information for Members. Then click on Internet Doctor Directory.
Make an appointment for an examination. Tell the doctor's office that you are covered by VSP through the Line Construction Benefit Fund. You will be asked for the following information: your name and your birth date. Before your scheduled examination, the VSP doctor will obtain authorization for services from VSP.
Keep the appointment and make any necessary payments for the additional materials agreed upon by you and the VSP doctor. The doctor and VSP will take care of the rest.

Using an Out-of-Network Provider

If you use an out-of-network provider, you must pay the bill in full and get an itemized paid receipt. You cannot assign these benefits. Then you must submit a copy of your itemized receipt along with your name and address to VSP for reimbursement (see page 13). VSP will reimburse you for the reasonable and customary amount of the charges up to but not to exceed the amounts shown in the Out-of-Network column on the Schedule of Benefits/Vision Care Benefits. There is no assurance that the reimbursement amounts will be sufficient to reimburse you for the amount you paid the out-of-network provider for the examination and materials.