/depts/,/depts/uwhealth/,/depts/uwhealth/benefits/,/depts/uwhealth/benefits/open-enrollment/,/depts/uwhealth/benefits/open-enrollment/uwhc-open-enrollment/,/depts/uwhealth/benefits/open-enrollment/uwhc-open-enrollment/vsp-vision-care/,/depts/uwhealth/benefits/open-enrollment/uwhc-open-enrollment/vsp-vision-care/resources/,

/depts/uwhealth/benefits/open-enrollment/uwhc-open-enrollment/vsp-vision-care/resources/vision-comparison2018.pdf

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UWHC,UWMF,

Departments & Programs,UW Health,Benefits,UW Health Open Enrollment,UWHC Open Enrollment,VSP Vision Care,Resources

2018 Vision Comparison

2018 Vision Comparison - Departments & Programs, UW Health, Benefits, UW Health Open Enrollment, UWHC Open Enrollment, VSP Vision Care, Resources


Comparison Chart of 2018 Vision Coverage Options
Vision Benefit EPIC Benefits+ Vision Plan
Option
Enrollment in Benefits + required; additional
cost
Premiums Employees
Employee Only $3.64
Employee + Spouse $6.40
Employee + Child(ren) $6.40
Family $9.44
Vision Benefit In-Network Benefits In-Network Benefits Non-Network Benefits
Routine Eye Examination Copay Not covered Covered in full once every calendar year
after $15 copay.
$45 maximum reimbursement allowance.
Lenses (Spectacle or Contact) Copay Every 12 months - $25 copay
$25 copay applies once towards lenses
and frames.
Maximum reimbursement allowance:
Single Vision - $33
Bifocal - $50 Trifocal - $66 Lenticular - $80
Benefit Frequency
Lenses Every 12 months based upon date
Frames Every 24 months based upon date
Frames
Davis Vision Collection Frames
Fashion $0
Designer $0
Premier $25
Non-Collection Frame Allowance
$130 allowance. Member receives 20%
4
discount on
charges over
$130.
Spectacle Lenses
Single Vision / Lined Bifocal / Lined Trifocal / Lenticular Plastic lenses included. Covered in full after copay. Maximum reimbursement allowance: Single
Vision - $33
Bifocal - $50 Trifocal - $66
Lens Upgrades - Member Pays Discounted Cost
Polycarbonate Lenses (Child/Adult) $0 / $30 $0 for children / 20-25% discount adult
Scratch Resistent Coating $0 $0
Ultraviolet (UV) Coating $12 Covered in full after copay.
Scratch Protection Plan: Single Vision / Multifocal $20 / $40
Anti-Reflective Coating: Standard/Premium/Ultra $35 / 48 / 60
Tinting of Plastic Lenses: Solid Tint / Gradient Tint $0
High-Index Lenses
2
$55
Progressive Lenses
3
: Standard / Premium $50 / $90 $55 / $95-105
Blended Invisible Bifocals $20
Photosensitive Lenses: Glass / Plastic $20 / $65
Polarized Lenses $75
Intermediate Vision Lenses $30
Contact Lenses
Contact Lenses in Lieu of Eyeglasses
Collection Series Contacts Covered up to 8 boxes N/A N/A
Conventional
Disposable/Planned Replacement
Evaluation, Fitting & Follow Up
Standard Contact Lenses Included at no cost
Specialty Contact Lenses $60 allowance. Member receives 15% discount on
charges over
$60.
Value Added Features
Laser Vision Discount Network
Up to 25% off provider’s Usual & Customary or 5% off
advertised specials, whichever is lower.
Average 15% discount with contracted
facilities, including TLC. 5% discount on
promotional price offered through
contracted facilities.
No additional discounts or reimbursements
available at a non- contracted facility.
Routine Retinal Screening Not applicable $39 max copay Not applicable
Replacement Contact Lens Program (Lens 123!
®
) Mail order program - free membership. N/A N/A
1
Special lens designs, materials, powers, and frames may require additional cost.
2
Does not apply to all forms of high-index lenses.
3
Does not apply to all forms of progressive lenses.
4
Members receive full allowance towards everyday low prices at Walmart and Sam's Club. Additional discounts do not apply.
Revised 09/2017
stateofwiemployees.vspforme.com
VSP KidsCare Program
The VSP KidsCare program provides extra benefits for dependent children (under 26). The
KidsCare program is included in the plan at no additional cost
• Two vision exams per year
• Impact resistant lenses
• Lens replacement annually or more often if needed
• Frames replaced annually with $25 copay
DISCLAIMER: If there are differences in this document and the Group Policy, the Group Policy is the governing document. The comparison chart is only a general outline of benefits. You can find a more detailed
description of coverage in the applicable certificate of insurance.
Website
http://www.epiclife.com/wi- state-
employees/
$130 allowance. Member receives 15% discount on
charges over
$130.
Contact lens allowance of $150 can be
applied towards the contact lens exam as
well as contact lens materials.
$105 maximum reimbursement allowance
applies towards contact lens exam as well as
contact lens materials.
Contact lens exam (fitting & follow-up) is
discounted 15% through a VSP provider;
maximum copay of $40. Contact lens
allowance of $150 can be applied towards
contact lens materials.
$105 maximum reimbursement allowance
applies towards contact lens exam as well as
contact lens materials.
No additional discounts or reimbursements
available for optional lens treatements at a Non-
Network provider.
All other optional lens treatments are
available at cost-controlled pricing
averaging between 20-25% discount.
All other optional lens treatments are
available at cost-controlled pricing
averaging between 20-25% discount.
Every calendar year.
Every other calendar year.
$25 copay applies once towards lenses
and frames.
$150 allowance towards frames
20% savings on any amount over the
allowance
Available every calendar year for
dependent children
$70 maximum reimbursement allowance.
VSP Vision Insurance
Employees
$6.54
$13.08
$14.73
$23.54