*If the eye exam is received through a non-VSP Provider, pay the full amount of the bill and submit a Claim for reimbursement.

The Plan provides vision benefits through Vision Service Plan (VSP). This benefit is intended for routine vision care. The diagnosis and treatment of eye disease or injury is covered under the medical benefits.

Eligibility for Vision Benefits

All covered Plan I Participants and Dependents are eligible for VSP’s Exam Plus Plan. Vision benefits are not available to Plan II Participants or Dependents.

Finding In-network Providers

You may search for Providers that participate in VSP’s Exam Plus Plan, as described below:

• Call (800) 877-7195 and ask for a list of VSP participating doctors to be mailed to you. Or, you may simply enter a specific doctor’s office telephone number to verify the doctor’s participation in the VSP Exam Plus network.
• Visit the VSP website at www.vsp.com to locate an In-network Provider near you.
• Contact VSP by mail at:
  • Vision Service Plan
    P.O. Box 997100
    Sacramento, CA 95899-7100

Using the Vision Benefit

To use the Plan’s vision benefit, follow the steps below:

1. Locate a VSP Exam Plus provider.
2. Call the doctor to make an appointment.
3. Identify yourself as a VSP Exam Plus Participant in the SAG-AFTRA Health Plan.
4. Provide the doctor with your health care ID number. If the patient is a Dependent child, you must also provide the patient’s date of birth.

Eye Exams and Discounts on Corrective Lenses

The Plan’s vision benefit includes one eye exam every calendar year for covered Plan I Participants and Dependents. Under the Plan’s vision benefit, eye exams include an analysis of the patient’s visual functioning and a prescription for corrective lenses when necessary. The exam includes additional services and follow-up eye care for Participants and Dependents with type 1 diabetes.

The Plan also offers discounts on complete pairs of glasses as well as professional services associated with prescription contact lenses. These discounts are applied to the doctor’s usual and customary charge and are only guaranteed when you purchase them within 12 months of the last covered eye exam from any VSP In-network Provider. For glasses, you must purchase both lenses and frames. Contact lenses are available at the VSP doctor’s normal retail price.

Laser Vision Correction Surgery

The VSP Exam Plus Plan network provides a discount on three commonly performed laser vision correction procedures – laser-assisted in-situ keratomileusis (LASIK), custom LASIK11 and photorefractive keratectomy (PRK). Although the Plan does not pay the cost of the surgery, you have access to the procedures at reduced fees through VSP’s network of doctors and laser centers. You will pay the Provider’s discounted rate, which will not exceed the following:

• $1,500 per eye for PRK;
• $1,800 per eye for LASIK; or
• $2,300 per eye for Custom LASIK.

These fees include both pre- and post-operative care through your VSP doctor.

To schedule a complimentary screening and consultation about the benefits and risks of laser vision correction surgery, contact an in-network doctor. You may locate in-network VSP Providers at www.vsp.com or by calling (800) 877-7195.