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Your VSP Vision Benefits Summary

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Your VSP Vision Benefits Summary BASIC PLAN Delta Pilot Pension Preservation and VSP provide you with an affordable eyecare plan. Sign up for VSP today. VSP Coverage Effective January 1, 2011 Doctor Network VSP Choice Your Coverage with A VSP Doctor WellVision Exam® focuses on your eye health and overall wellness $10 copay every calendar year Prescription Glasses • $15 copay Lenses every calendar year • Single vision, lined bifocal, and lined trifocal lenses • Polycarbonate lenses for dependent children Frame every other calendar year • $125 allowance for a wide selection of frames Your VSP Vision Benefits Summary • 20% off the amount over your allowance -OR- Why enroll in a VSP® Vision Care plan? We'll help keep you and Contact Lens Care • No copay every calendar year your eyes healthy. Plus, you'll get a great value on your eyecare $120 allowance for contacts and the contact lens exam and eyewear. (fitting and evaluation). Current soft contact lens wearers may qualify for a special program that includes a contact lens exam and initial You'll like what you see with VSP. supply of replacement lenses. Diabetic Eyecare Plus Program Value and Savings. You'll get great benefits on your exam $20 copay and eyewear at an affordable price. Services related to Type 1 and Type 2 diabetes, visit vsp.com or ask your VSP doctor for details. Personalized Care. You'll get quality care that focuses on your Extra Discounts and Savings eyes and overall wellness with a WeliVision Exam" from a VSP doctor. Glasses and Sunglasses They'll look for vision problems and signs of other health conditions. • Average 20-25% savings on all non-covered lens options When you see a VSP doctor, you'll get the most out of your benefit • 20% off additional glasses and sunglasses, including and have lower out-of-pocket costs. Plus, you'll be 100% happy with lens options, from any VSP doctor within 12 months of your last Well Vision Exam your eyecare and eyewear from a VSP doctor or we'll make it right. Contacts • 15% off cost of contact lens exam (fitting and Eyewear. Choose the eyewear that's right for you and your evaluation) budget. From classic styles to the latest designer fashions, you'll Laser Vision Correction find hundreds of options for you and your family. • Average 15% off the regular price or 5% off the promotional price. Discounts only available from contracted facilities. Choice of Providers. With open access to see any eyecare Your Contribution provider, you can see the one who's right for you. Choose a VSP doctor or any other provider. To find a VSP doctor, visit vsp.com or Employee Only $6.34 Employee + One Dependent.. $12.68 call 800.877.7195. Employee + Family $14.88 Your Coverage with Other Providers Enroll today. You'll be glad you did. Visit vsp.com for details, if you plan to see a provider other than a VSP doctor. Once your plan is effective, register on vsp.com to view a complete description of your benefits. To use your vision coverage, simply tell ~m ~~ro Single vision lenses Up to $30 your eyecare provider that you have VSP. No ID card is necessary. Lined bifocal lenses , ,., Up to $50 Lined trifocal lenses Up to $65 Contact us. vsp.com 1800.877.7195 Frame.......... .. Up to $70 Contacts Up to $105 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. CAT#0061O JOB#3755CM 6/10' .~'" PREMIUM PLAN Delta Pilot Pension Preservation and VSP provide you with an affordable eyecare plan. Sign up for VSP today. VSP Coverage EffEctIvE January 1, 2011 Doctor NEtwork VSP ChoICE Your Coverage with A VSP Doctor WellVision Exam®focuses on your eye health and overall wellness • $10 capay every calendar year Prescription Glasses • $15 capay Lenses every calendar year • Single vision, lined bifocal, and lined trifocal lenses • Progressive lenses covered with a $40 copay • Polycarbonate lenses for dependent children Frame every other calendar year r • $125 allowance for a wide selection of frames • 20% off the amount over your allowance Why enroll in a VSP<!>Vision Care plan? We'll help keep you and -OR- Contact LEns Care your eyes healthy. Plus, you'll get a great value on your eyecare No copay every calendar year and eyewear. $120 allowance for contacts and the contact lens exam (fitting and evaluation). Current soft contact lens wearers may qualify for a special You'll like what you see with VSP. program that includes a contact lens exam and initial supply of replacement lenses. Value and Savings. You'll get great benefits on your exam Extra Discounts and Savings and eyewear at an affordable price. Glasses And Sunglasses • Average 20-25% savings on all non-covered lens Personalized Care. You'll get quality care that focuses on your options • 20% off additional glasses and sunglasses, including eyes and overall wellness with a WeliVision Exam<'lf>rom a VSP doctor. lens options, from any VSP doctor within 12 months of They'll look for vision problems and signs of other health conditions. your last Well Vision Exam When you see a VSP doctor, you'll get the most out of your benefit Contacts • 15% off cost of contact lens exam (fitting and and have lower out-at-pocket costs. Plus, you'll be 100% happy with evaluation) your eyecare and eyewear from a VSP doctor or we'll make it right. Laser VisIon CorrectIon • Average 15% off the regular price or 5% off the Eyewear. Choose the eyewear that's right for you and your promotional price. Discounts only available from contracted facilities. budget. From classic styles to the latest designer fashions, you'll find hundreds of options for you and your family. Your Contribution EmployEE Only $7.62 EmployEE + OnE Dependent $15.24 Choice of Providers. With open access to see any eyecare Employee + Family $17.92 provider, you can see the one who's right for you. Choose a VSP doctor Your Coverage with Other Providers or any other provider. To find a VSP doctor, visit vsp.comor Visit vsp.com for details, if you plan to see a provider call 800.877.7195. other than a VSP doctor. Enroll today. You'll be glad you did. Exam Up to $45 Single vision lenses Up to $30 Lined bifocal lenses Up to $50 Once your plan is effective, register on vsp.com to view a complete Lined trifocal lenses Up to $65 description of your benefits. To use your vision coverage, simply tell Frame Up to $70 your eyecare provider that you have VSP. No ID card is necessary. Contacts Up to $105 VSP guarantees service from VSP doctors only. In the event of a conflict between this information and your Conta 95 organization's contract with VSP, the terms of the contract will prevail. CATJl00610 J08113755CM 6110.
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