Verdugo Hills vision insurance

USC Verdugo Hills vision insurance plan is administered by Vision Service Plan (VSP). See A Look at Your VSP Vision Coverage.

BENEFIT In network (VSP Choice Provider)

The Plan pays:

Out of network

The Plan pays:

Well vision exam (one per year) 100% after a $25 copay* 100% (up to $45) after a $25 copay*
Frames** (every other calendar year) 100% (up to $110) after a $25 copay* 100% (up to $70) after a $25 copay*
Lenses (every other calendar year)

  • ž Single vision
  •  Lined bifocal
  • ž Lined trifocal
  • ž Lenticular

(includes polycarbonate lenses for dependent children)

100% after a $25 copay*  

100% after a $25 copay*, up to a maximum of:

$30 (single vision)

$50 (lined bifocal)

$65 (lined trifocal)

Not covered (lenticular)

Lens options (every other calendar year)

  • Standard progressive
  • Premium progressive
  • Custom progressive
100% after a $55 copay (standard progressive)

100% after a $95‐$105 copay (premium progressive)

100% after a $150‐$175 copay (custom progressive)

 

100% (up to $50) after a $25 copay

Contacts (every other calendar year; in lieu of glasses) 100% (up to $110) 100% (up to $105)
Fitting and evaluation for contact lenses (every other calendar year; in lieu of glasses) 100% after a copay of up to $60 Not covered
*Only one copay applies for the exam, lenses and frames

**You automatically get an extra $20 to spend when you choose a featured frame brand

Go to vsp.com/specialoffers for details.

VSP | www.vsp.com

(800) 877-7195

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