Vision
Healthy eyes and clear vision are an important part of your overall health and quality of life. You may enroll yourself and your eligible dependents or you may waive vision coverage. You do not have to be enrolled in medical coverage to elect vision coverage or cover the same dependents under medical and vision.
Although vision care services and supplies are covered in-network and out-of-network, your benefits are generally greater when you use in-network providers. Your costs are based on the family members you choose to cover.
Guardian VSP Vision PPO
Plan Information
Plan Name: Guardian VSP Vision PPO
Policy Number: 00074656
Effective Date: 01/01/2025
Provider Network: VSP Choice
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
In-Network
Exams
100% after $10 copay
Single Vision Lenses
100% after copay
Bifocal Lenses
100% after copay
Trifocal Lenses
100% after copay
Frames
Up to $150 after copay
Contacts (in lieu of glasses)
Contact Fitting & Follow-up
100% after $60 copay
Medically Necessary
100% after $25 copay
Elective/Convenience
Up to $150
Frequency
Exams
Once per calendar year
Lenses
Once per calendar year
Frames
Once per calendar year
Contacts
Once per calendar year
Out-of-Network Reimbursement
Exams
Up to $39
Single Vision Lenses
Up to $23
Bifocal Lenses
Up to $37
Trifocal Lenses
Up to $49
Frames
Up to $46
Contacts (in lieu of glasses)
Contact Fitting & Follow-up
Included in Exam Allowance
Medically Necessary
Up to $210
Elective/Convenience
Up to $100
Frequency
Exams
Once per calendar year
Lenses
Once per calendar year
Frames
Once per calendar year
Contacts
Once per calendar year