USC Verdugo Hills vision insurance plan

USC Verdugo Hills vision insurance plan is administered by VSP.

VISION
 

BENEFIT

In‐Network

(VSP Choice Provider)

Out‐of‐Network
 

Well Vision Exam

(one exam per year)

 

The Plan pays 100% after a $25 copay*

 

The Plan pays 100% (up to $45)

after a $25 copay*

Frames** (every other calendar year) The Plan pays 100% (up to $110)

after a $25 copay*

The Plan pays 100% (up to $70)

after a $25 copay*

 

Lenses (every other calendar year)

ž Single Vision

ž Lined Bifocal

ž Lined Trifocal

ž Lenticular

(includes polycarbonate lenses for dependent children)

 

 

 

 

 

The Plan pays 100%

after a $25 copay*

 

 

 

The Plan pays 100% after a

$25 copay*, up to a maximum of:

 

$30

$50

$65

Not Covered

 

Lens Options (every other

calendar year)

ž Standard Progressive

ž Premium Progressive

ž Custom Progressive

 

 

 

 

The Plan pays 100% after a $55 copay The Plan pays 100% after a $95‐$105 copay The Plan pays 100% after a $150‐$175 copay

 

 

 

 

The Plan pays 100% (up to $50)

after a $25 copay

 

Contacts (every other calendar year)

(in lieu of glasses)

 

 

The Plan pays 100% (up to $110)

 

 

The Plan pays 100% (up to $105)

Fitting and Evaluation

for Contact Lenses (every other calendar year)

(in lieu of glasses)

 

 

The Plan pays 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