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IBEW Local 11-LA NECA Active Health Plan
BenefitTabs

BenefitTabs

VSP
Vision is covered by Vision Service Plan (VSP) for all participants in the Anthem Blue Cross and UnitedHealthcare. Kaiser participants get all vision services, except prescription safety glasses, through Kaiser.

Getting Services
  1. Choose a VSP doctor at vsp.com or call 800-877-7195.
  2. Make an appointment and tell the doctor you are a VSP member.
Benefit
Your Copayment
Your Coverage
Vision Exam - 1 every 12 months
$5
VSP Network Provider
Non-VSP Provider (Out-of-Network reimbursement amounts)
Up to $45
Lenses - 1 pair every 12 months $10 (lenses and/or frame) Single vision, lined bifocal and lined trifocal lenses are covered. Single vision up to $45 allowance.
Lined bifocal up to $65 allowance.
Lined trifocal up to $85 allowance.
Frames - 1 frame every 24 months $10 (lenses and/or frame)
$120 Allowance
Up to $47
Contact Lenses $0
$120
Up to $105

Safety Glasses - for eligible Participants in Anthem Blue Cross and UnitedHealthcare Plans

Note: This benefit covers participants only - not dependents, and the same maximum allowed amounts apply as shown above.
Benefit  
Copayment
Exam - 1 every 12 months
$5

There will not be a separate exam or copayment charge if the safety glass exam is conducted at the time of the annual exam.
Lenses - 1 every 12 months
$10 (lenses and/or frame)
Frames - 1 every 24 months
$10 (lenses and/or frame)

Safety Glasses - for eligible Participants in the Kaiser Plan

Note: This benefit is for participants only - not dependents.
Benefit  
Copayment
Exam - 1 every 12 months
$25
Lenses - 1 every 12 months
$10 (lenses and/or frames)
Frames - 1 every 24 months
$10 (lenses and/or frames)
Out-of-Network Reimbursement Amounts
Exam - Up to $45
Lenses

Single Vision - Up to $55
Bifocal - Up to $75
Trifocal - Up to $87
Frame - Up to $30
Additional Information Customer Service Phone Number: 1-800-877-7195
Website: www.vsp.com

 

 

 

 

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