" Tippecanoe School Corporation & VSP providing you with an affordable eyecare plan. Important Info VSP Coverage Effective January 1, 2011 Doctor Network VSPSignature Your Coverage with a VSP Doctor WellVision Exam® focuses on your eye health and overall wellness • $10.00 copay every 24 months Prescription Glasses • $25.00 copay Lenses every 24 months • Single vision, lined bifocal & lined trifocal lenses. • Polycarbonate lenses for dependent children. Frame every 24 months • $115.00 allowance fora wide selection of frames • 20% off the amount over your allowance. Your VSP Vision Benefits Summary ~OR~ Contact Lens Care • No copay applies every 24 months Why enroll in a VSP® Vision Care plan? We'll help keep you and $120.00 allowance for contacts and the contact lens your eyes healthy. Plus, you'll get a great value on your eyecare exam (fitting & evaluation). and eyewear. Current soft contact lens wearers may qualify for a special program that includes a contact lens exam and initial supply of lenses. You'll like what you see with VSR Extra Discounts & Savings at a VSP Doctor Glasses & Sunglasses Value and Savings. You'll get great benefits on your exam • Average 35 - 40% savings on all non-covered lens and eyewear at an affordable price. options • 30% off additional glasses and sung/asses, including lens options, from the same VSP doctor on the same Personalized Care. You'll get quality care that focuses on your day as your WellVision Exam. Or get 20% off from any eyes and overall wellness with a WellVision Exam® from a VSP doctor. VSP doctor within 12 months of your last covered They'll look for vision problems and signs of other health conditions. WellVision Exam. Contacts When you see a VSP doctor, you'll get the most out of your benefit • 15% off cost of contact lens exam (fitting & evaluation) and have lower out-of-pocket costs. Plus, you'll be 100% happy with Available from any VSP doctor within 12 months of your last covered WellVision Exam. 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 • After surgery, use your frame allowance (if eligible) for find hundreds of options for you and your family. sunglasses from any VSP doctor Your Coverage with Other Providers Choice Of Providers. With open access to see any eyecare If you plan to see a provider other than a VSP doctor, provider, you can see the one who's right for you. Choose a VSP doctor please visit vsp.com or call (800) 877-7195 for details. or any other provider. To find a VSP doctor, visit vsp.com or Exam Up to $50.00 call 800.877.7195. Single vision lenses Up to $50.00 Bifocal lenses Up to $75.00 Trifocal lenses Up to $100.00 Enroll today. You'll be glad you did. Frame Up to $70.00 Contacts Up to $10500 Once your plan is effective, register on vsp.com to view a complete VSP guarantees service from VSP doctors only. For more description of your benefits. To use your vision coverage, simply tell information, please contact one of our Benefit Advisors at (800) 877-7195. your eyecare provider that you have VSR No ID card is necessary. In the event of a conflict between this information and your organization's contract with VSP, the terms of the Contact us. vsp.com I 800.877.7195 contract will prevail. VSP Confidential & Proprietary VSQ Vision care for life I CAT#00610 JOB#3755CM 6/10.