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Get the best in eyecare and eyewear with CITY OF MODESTO and VSP® Vision Care. Using your VSP benefit is easy. Register at vsp.com Once your plan is effective, review your benefit information. Find an eyecare provider who’s right for you. The decision is yours to make—choose a VSP doctor, a participating retail chain, or any out-of-network provider. To find a VSP provider, visit vsp.com or call [PHONE REDACTED]. At your appointment, tell them you have VSP. There’s no ID card necessary. If you’d like a card as a reference, you can print one on vsp.com. That’s it! We’ll handle the rest—there are no claim forms to complete when you see a VSP provider. Diabetic EyeCare Annual eye exams can help prevent diabetes-related blindness. If you have type 1 or type 2 diabetes, you can get both your routine and diabetic eyecare from your VSP doctor—the one who knows your eyes best. Ask your VSP doctor for details. Progressive Lenses Do you need bifocal or trifocal lenses, but don’t want a line on your glasses? With progressive lenses you’ll get a smooth transition to help you see clearly at varying distances. Talk to your VSP provider about VSP RevealTM progressive lenses. Visit vsp.com for details on your coverage and more information on progressive lenses. Plan Information VSP Coverage Effective Date: 01/01/2016 VSP Provider Network: VSP Signature CITY OF MODESTO and VSP provide you with an affordable eyecare plan. Copay Description Benefit Your Coverage with a VSP Provider $10 WellVision Exam Focuses on your eyes and overall wellness Every 12 months $10 Prescription Glasses Included in Prescription Glasses Frame $145 allowance for a wide selection of frames or $165 allowance for featured frame brands (see 'Extra Savings' below) 20% savings on the amount over your allowance $80 allowance at Costco® Every 24 months Included in Prescription Glasses Lenses Single vision, lined bifocal, and lined trifocal lenses Polycarbonate lenses for dependent children Every 12 months $0 Lens Enhancements Progressive lenses Average savings of 35-40% on other lens enhancements Every 12 months Up to $60 Contacts (instead of glasses) $105 allowance for contacts; copay does not apply Contact lens exam (fitting and evaluation) Every 12 months $20 Diabetic Eyecare Plus Program Services related to diabetic eye disease, glaucoma and age-related macular degeneration (AMD). Retinal screening for eligible members with diabetes. Limitations and coordination with medical coverage may apply. Ask your VSP doctor for details. As needed Glasses and Sunglasses Extra Savings Extra $20 to spend on featured frame brands. Go to vsp.com/specialoffers for details. 30% savings on additional glasses and sunglasses, including lens enhancements, from the same VSP provider on the same day as your WellVision Exam. Or get 20% from any VSP provider within 12 months of your last WellVision Exam. Retinal Screening No more than a $39 copay on routine retinal screening as an enhancement to a WellVision Exam Laser Vision Correction Average 15% off the regular price or 5% off the promotional price; discounts only available from contracted facilities After surgery, use your frame allowance (if eligible) for sunglasses from any VSP doctor Your Coverage with Out-of-Network Providers Visit vsp.com for details, if you plan to see a provider other than a VSP network provider. Lined Trifocal Lenses to $100 Exam to $50 Progressive Lenses to $75 Frame to $70 Contacts to $105 Single Vision Lenses to $50 Lined Bifocal Lenses to $75 Coverage with a participating retail chain may be different. Once your benefit is effective, visit vsp.com for details. Coverage information is subject to change. In the event of a conflict between this information and your organization’s contract with VSP, the terms of the contract will prevail. Based on applicable laws, benefits may vary by location. Visit vsp.com or call [PHONE REDACTED] for more details on your vision coverage and exclusive savings and promotions for VSP members. 1Brands/Promotion subject to change. ©2014 Vision Service Plan. All rights reserved. VSP, VSP Vision care for life, and WellVision Exam are registered trademarks of Vision Service Plan. Flexon is a registered trademark of Marchon Eyewear, Inc. All other company names and brands are trademarks or registered trademarks of their respective owners. Your Vision Benefits Summary