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VISION SERVICE COVERAGE
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Benefit
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Frequency
(based
on
service
year)
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Copayment
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Coverage
from
a
Network
Doctor
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Out-of-Network
Reimbursement
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| Eye
Care Wellness -
Regular exams are essential for protecting your
visual wellness. |
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| Exam |
12 Months
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$15.00
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Covered in full
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Up
to $25.00
allowance
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Prescription
Eyewear - You may
choose between glasses or contacts. Remember
if
you
choose contacts, you will not be eligible to receive glasses (lenses and
frame) in
the
same service period.
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| Lenses |
12
Months |
$15.00* |
Single
Vision,
lined
bifocal
lens,
lined
trifocal
lenses
and
tints are
covered
in full1
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Single
vision up
to
$30 allowance
Lined
bifocal up
to
$35 allowance
Lined
trifocal up
to
$45 allowance
Tints
up to $5
allowance
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| Frame |
12
months |
$15.00* |
Covered
up to
$140
allowance2
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Up
to $105
allowance
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Contact
Lens |
12 Months
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None
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Covered
up to
$140
allowance
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Up
to $105
Allowance
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One $10 copay applied to Lenses & Frames |
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Your
allowance applies to the cost of your contact lens exam and your contact
lenses.
You'll
receive a 15 percent savings off the cost of your contact lens exam from a
VSP
doctor.
Your contact lens exam is performed in addition to your routine eye
exam to
check
for eye health risks associated with improper wearing or fitting of
contacts.
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| Value
Added Discounts |
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Laser
VisionCareT - The Vision Coverage Company has
contracted with many of the
nation's
finest laser surgery facilities and doctors, offering you a discount off
PRK and
LASIK
surgeries, available through contracted laser centers
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Contact
Lenses - Valuable savings are available on annual
supplies of certain brands
of
contacts. You can receive
these member preferred prices, even if you use your
coverage
for glasses.
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Prescription
Glasses - Receive
20 percent savings when you purchase non-covered
pairs
of prescription glasses, including prescription sunglasses from the same
in-network
doctor
within 12 months of your last eye exam.
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1 Lens options, which can enhance the appearance, durability and
functions of
your glasses, are available
to you at member preferred pricing.
Ask you doctor for details.
2 If you choose a frame valued at more than your allowance, you'll
save 20
percent on your out-of-pocket
costs for frames.
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This
is a brief summary of benefits under the Vision Program.
Complete terms
and conditions of coverage and benefits are set forth in the Master Policy
issued to Student Osteopathic Medical
Association.
The
plan is underwritten by VSP.
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