Vision Insurance

Group Name: Cuesta College
Provider: Vision Services Plan (VSP)
Group #: 30071230
 
 
General Plan Information  In - Network Out-of-Network
Copay    
 Examination 100% up to $50/optometric; up to $60/ophthalmologic
Benefit Frequency     
Examination  12 months 12 months 
 Lenses 12 months 12 months
 Frames 12 months 12 months
 Contacts 12 months 12 months
Covered Services     
 Lenses    
Single Vision Lens 100% up to $43
Bifocal Lens 100% up to $60
Trifocal Lens 100% up to $75
Lenticular 100% up to $120 for Monofocal; up to $200 for Multifocal
Contact Lenses    
Medically Necessary 100% prior authorization is required up to $200/hard; up to $250/soft; prior authorization is required
Elective up to $150 up to $120
Frames up to $200 up to $40