How the Plan Pays Benefits


Trust Vision Plan
Benefits	VSP Preferred Provider	Non-VSP Provider Reimbursement
Exam	Covered in full	Up to $70
Lenses
Single vision	Covered in full*	Up to $50
Lined bifocal	Covered in full*	Up to $75
Lined trifocal	Covered in full*	Up to $100
Polycarbonate lenses (for dependent children)	Covered in full	Not covered
Progressive	35-40% discount off usual and customary charges for progressive lens option	Up to $100
Frame	Covered up to $100, 20% off any out-of-pocket costs	Up to $75
Contacts in lieu of lenses and a frame	Covered up to $137	Up to $137 for contact lens exam and contacts
Contact Lens Exam (fitting and evaluation)	Covered in full after a not-to-exceed copay of $60
Benefit Frequency
Exam	Every 12 months for children up to age 17, every 24 months for adults
Lenses	Every 12 months for children up to age 17, every 24 months for adults
Frame	Every 24 months for children and adults