Welcome to VSP® Vision Care. California CPA & VSP provide you with two affordable eyecare plan options. We’ll help keep you and your eyes healthy through personalized care from a doctor you can trust. To find a VSP doctor near you, visit vsp.com.

Vision Standard Plan (with a VSP doctor) Vision Enhanced Plan (with a VSP doctor)

Doctor Network...... VSP Signature Doctor Network...... VSP Signature WellVision Exam® focuses on your eye health and WellVision Exam® focuses on your eye health and overall wellness overall wellness $15 copay for exam …………….…every service year $15 copay for exam …………….…every service year

Prescription - $15 copay Prescription Glasses - $15 copay ...... every other service year Lenses...... every service year • Single vision, lined bifocal, lined trifocal lenses • Single vision, lined bifocal, lined trifocal lenses • Polycarbonate lenses for dependent children • Polycarbonate lenses for dependent children

Frame ...... every other service year Frame...... every other service year • $130 allowance for a wide selection of frames • $130 allowance for a wide selection of frames • 20% off the amount over your allowance • 20% off the amount over your allowance

–OR– –OR– Contact Care Care Up to $60 copay...... every other service year Up to $60 copay ...... every service year • $130 allowance for contacts: copay does not apply. • $200 allowance for contacts: copay does not apply. Contact lens exam (fitting and evaluation) Contact lens exam (fitting and evaluation)

Additional Benefits, Extra Savings and Discounts (applies to both plans)

Glasses and Diabetic Eyecare Program • Average 35-40% savings on non-covered lens options • Allows you to obtain medical eyecare services related • 30% off additional glasses and sunglasses, including to Type 1 diabetes which is usually diagnosed in lens options, from the same VSP doctor on the same children and young adults, who are at higher risk for day as your WellVision Exam; or get 20% off from diabetic eye disease. any VSP doctor within 12 months of your last Your Benefits from Other Providers WellVision Exam. • Visit vsp.com for details & allowances, if you plan to Contacts see a provider other than a VSP doctor. • 15% off the contact lens exam (fitting and evaluation) Coverage with Out of Network Providers: Laser Vision Correction After subtracting your copay, the plan will reimburse you for charges up to the specified limits, see below: • Average 15% off the regular price or 5% off the promotional price, discounts only available from Open Access Schedule (OAS) contracted facilities Exam...... Up to $50.00 • After surgery, use your frame allowance (if eligible) for Frame...... Up to $70.00 sunglasses from any VSP doctor Single vision lenses ...... Up to $50.00 Retinal Screening Lined bifocal lenses ...... Up to $75.00 • Guaranteed pricing on retinal screening as an Lined trifocal lenses ...... Up to $100.00 enhancement to your WellVision exam Progressive lenses...... Up to $75.00 Contacts...... Up to $105.00

©2010 Vision Service Plan. All rights reserved. VSP and WellVision Exam are registered trademarks of Vision Service Coverage information is subject to change. VSP guarantees service from VSP doctors only. In the event of a conflict between this information and your organization’s contract with VSP, the terms of the contract will prevail.