Choose a VSP network eye doctor from the largest network of independent doctors.  You may also buy materials online from eyeconic.com

You may choose to go outside of VSP’s eye doctor network, but your benefits will be reduced.  See “Out-of-Network Benefit Schedule” below

Get the most out of your benefit and greater savings with a VSP network doctor. If you visit an out-of-network doctor, you’ll likely have higher out-of-pocket expenses. Visit vsp.com or call 1-800-877-7195 to find a VSP network doctor.

*Lenticular lenses are magnifying lenses, designed so that when viewed from slightly different angels, different images are magnified.

Note: If you choose to see an out-of-network doctor, you’ll receive less coverage. Payment is expected at the time of your visit. Following your appointment, you’ll need to complete a claim form and include any itemized receipts. You can complete and submit the form on vsp.com or call 1-800-877-7195 to request a hard copy form. Address to Vision Service Plan, Attention: Claim Services, P.O. Box 385018, Birmingham, AL 35238-5018. Out-of-network coverage is not available in the states of Massachusetts and Washington, and coverage varies in the state of Maryland.

EXCLUSIONS AND LIMITATIONS OF BENEFITS

Some brands of spectacle frames may be unavailable for purchase as Plan Benefits, or may be subject to additional limitations.  Covered Persons may obtain details regarding frame brand availability from their VSP Member Doctor or by calling VSP’s Customer Care Division at (800) 877-7195.

NOT COVERED

• Services and/or materials not specifically included in this Schedule as covered Plan Benefits.
• Plano lenses (lenses with refractive correction of less than ± .50 diopter),
• Two pair of glasses instead of bifocals.
• Replacement of lenses, frames and/or contact lenses furnished under this Plan which are lost or damaged, except at the normal intervals when Plan Benefits are otherwise available.
• Orthoptics or vision training and any associated supplemental testing.
• Medical or surgical treatment of the eyes.
• Refitting of contact lenses after the initial (90-day) fitting period.
• Contact lens modification, polishing or cleaning.
• Local, state and/or federal taxes, except where VSP is required by law to pay.
• Services associated with Corneal Refractive Therapy (CRT) or Orthokeratology.

By purchasing this plan you are entering into a 1 year contract. You are required to make all payments, regardless of when benefits are used.

Vision insurance is provided by VSP.  Billing and premium collection services for VSP vision insurance is provided by DTC GLIC, LLC (d/b/a DTC GLIC Insurance Sales, LLC in California), a wholly owned subsidiary of The Guardian Life Insurance Company of America ("Guardian").  Guardian and DTC GLIC, LLC are not affiliated with VSP.  Guardian and DTC GLIC, LLC do not assume any responsibility or liability for non-Guardian products or services, including those offered by VSP.

Products are not available in all states. Coverage terms and conditions are set forth in the policy under which the individual consumer is insured, and such terms and conditions vary according to the laws of the state in which the policy was issued.  Policy limitations and exclusions apply. Please refer to your plan documents for a complete list of limitations and exclusions. Plan documents are the final arbiter of coverage. This policy provides VISION insurance only.

©2018 Vision Service Plan. All rights reserved. VSP and WellVision Exam are registered trademarks and VSP Individual Vision Plans is a trademark of Vision Service Plan. All other brands and marks are the property of their respective owners.

Trademarks of The Guardian Life Insurance Company of America (Guardian) are used with express permission. © 2018 Guardian