If You Don't Use A VSP Panel Doctor
If you choose to use a doctor who is not associated with VSP, you should obtain
a benefit form from VSP and bring it with you when you have your appointment.
You must pay the doctor's full fee and submit the benefit form along with the
doctor's itemized statement of charges to VSP within six months of receiving the
service. VSP will reimburse you according to the following schedule:
Professional Fees
Vision examination: up to $35
Materials
Single vision lenses: up to $25/pair
Bifocals: up to $40/pair
Trifocals: up to $50/pair
Lenticular lenses: up to $100/pair
Frames: up to $30/pair
Contact Lenses
In lieu of all other plan benefits (examination, lenses, and frames):
Medically necessary: up to $250
cosmetic: up to $110
All lens allowances are for two lenses.
If only one lens is needed, the allowance will be for half of the pair allowance.
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