Benefits Grid

Below is the features of the VSP. Your vision frame and contact lens allowance is increasing for 2025 from $175 to $200.

While you have a choice of what provider to see, we recommend finding an in-network provider to maximize your benefit.

Under the plan, when you select an out-of-network provider the benefits are limited. For out-of-network reimbursement, you pay the entire bill when services are rendered then file a claim form for reimbursement. Claims must be filed within 12 months of the date of service. Submit claims to:

Vision Services Plan
P.O. Box 997105
Sacramento, CA 95899-7105

More information can be obtained by calling VSP at 1.800.877.7195 or accessing www.vsp.com. Plan information and claim forms are available at www.vsp.com or available on Canvas > Life and career > About me > My benefits.

 

Plan Feature	In-Network	Out-of-Network
Claims Forms	Not required	Required
Examination (Once every 12 months)	100% after $10 co-pay	Up to $25
Lenses (Once every 12 months)
Single	100% after $20 co-pay	Up to $30
Bifocal	100% after $20 co-pay	Up to $35
Trifocal	100% after $20 co-pay	Up to $45
Lenticular	100% after $20 co-pay	Up to $60
Frames (once every 24 months)	100% within plan allowance ($200)	Up to $45
Contact Lenses (instead of a complete pair of prescription glasses)
If elective (not medically necessary)	Up to $200	Up to $105
If medically necessary (means by doctor’s authorization glasses cannot be worn)	100% after $20 co-pay	Up to $210

 Premiums can be found on Canvas.