VISION BENEFITS

The Health 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 major medical benefit.

Eligibility
Plan I Earned, Self-Pay and Senior Performer participants and their eligible dependents are eligible for the Exam Plus Plan. Vision benefits are not provided to Plan II Earned and Self-Pay participants and their eligible dependents. Nor are they provided to participants in the Lower Cost Self-Pay Plan.

How To Locate a VSP Provider

• You may call 1-800-877-7195 and request that a list of VSP participating doctors be mailed to you. Or, you may enter a specific doctor’s telephone number to verify the office’s participation in the VSP network.
• You may visit the VSP Web site at www.vsp.com to locate a participating provider near you.
• You may contact VSP through the mail at:
  Vision Service Plan, P.O. Box 997100, Sacramento,CA 95899-7100

How to Use the Benefit

1. Locate a VSP Exam Plus doctor.
2. Call the doctor to make an appointment.
3. Identify yourself as a VSP Exam Plus participant through the SAG-Producers Health Plan.
4. Provide the doctor with your Social Security Number. If the patient is a dependent child, you will also need to state the patient’s date of birth.

After you make an appointment, your doctor and VSP will handle the rest.

Vision Benefits

	Eye Exams	Glasses	Professional Services for Contact Lenses
Exam Plus Plan
In-Network	$10 co-payment; one exam per calendar year	20% discount	15% discount
Out-of-Network	80% of doctor’s customary charge up to a maximum payment of $50*; one exam per calendar year	No benefit	No benefit

* If the eye exam is received through a non-VSP provider, pay the full amount of the bill and submit a claim for reimbursement as described on page 76

The Exam Plus Plan includes an eye exam every calendar year for Plan I participants and their eligible dependents. Vision exams include an analysis of the patient’s visual functions, including prescription of corrective lenses when indicated. The Plan also offers discounts on complete pairs of glasses as well as professional services associated with prescription contact lenses. These discounts are off the doctor’s usual and customary charge.

Discounts on frames, lenses and professional fees for contact lenses are only guaranteed when you purchase them from the same VSP network provider who performed your eye exam. 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 Exam Plus Plan provides a discount on two commonly performed laser vision correction procedures – laser-assisted in-situ keratomileusis (LASIK) and photorefractive keratectomy (PRK). Although the Health 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. The most you will pay is $1,500 per eye for PRK or $1,800 per eye for LASIK. The fee includes both pre and post-operative care through your VSP doctor.

To schedule a complimentary screening and consultation on the benefits and risks of laser vision correction, call your VSP doctor. Participating doctors can also be located on VSP’s Web site at www.vsp.com or by calling toll free, 1-800-877-7195.