Vision Insurance Benefits Overview
This document explains how vision insurance helps protect eye health by covering costs not included in regular medical insurance, such as eye exams, glasses, and contact lenses.
Watch our video How vision insurance can help you see clearly as you get older. Vision insurance Vision insurance helps protect the health of your eyes by providing coverage for benefits that often aren’t covered by regular medical insurance. Protecting your eyesight means allowing for routine visits to the optometrist for eye exams, as well as coverage for glasses and contacts. Make sure your eyes remain in great shape at any age – no matter how much time you spend staring at digital screens. Who is it for? Even if you have perfect eyesight, it’s important to have regular eye exams to make sure you’re still seeing clearly. Most of us may eventually need vision correction, which is why we offer vision insurance to cover some of the costs. What does it cover? Vision insurance covers benefits not typically included in medical insurance plans. It covers things like routine eye exams, allowances towards the purchase of eyeglasses and contact lenses, as well as discounts on corrective Lasik surgery. Why should I consider it? Regular eye exams can detect more than failing eyesight, they can also pick up diseases like glaucoma and diabetes. Vision problems are one of the most prevalent disabilities in the United States, making vision insurance especially useful for anyone who regularly needs to purchase eyeglasses or contacts, or anyone who simply wants to help protect their eyesight and general health. You willreceive these benefits ifyou meetthe conditions listedin the policy. 20/20 coverage Davidnotices thathis vision is deteriorating. He goes in foran eye exam, andis diagnosedwith myopia, which means he needs glasses. Average cost of vision exam: $171 Average cost of frames and lenses: $350 Total cost: $521 With aVision policyfrom Guardian, Davidpays just$10 forhis eye exam. After$25 in copay, his lenses are fully covered, andhe pays $96 forhis frames. David’s total out-of-pocket expense is $131, saving him $390. This example is for illustrative purposes only. Your plan’s coverage mayvary. See yourplan’s information on the following pages for specific amounts and details. GUARDIAN® is a registered trademark of The Guardian Life Insurance Company of America AesopIntermediateLLC Kit created 12/05/2022 ALL ELIGIBLE EMPLOYEES Groupnumber:00554984 2020-104313 (07/22) 7
Your vision coverage GUARDIAN® is a registered trademark of The Guardian Life Insurance Company of America Aesop IntermediateLLC Kit created 12/05/2022 ALL ELIGIBLE EMPLOYEES Groupnumber:00554984 Option 1: Significant out-of-pocket savings available with your Full Feature plan by visiting one of VSP’s network locations, including one of the largest private practice provider networks, Visionworks and contracted Pearle Vision locations. Your Vision Plan Full Feature Your Network is VSP Choice Network Your Monthly premium $ 5.46 You and Spouse $ 10.33 You and Child(ren) $ 10.52 You, Spouse and Child(ren) $ 16.67 Copay Exams Copay $ 20 Materials Copay (waived for elective contact lenses) $ 20 Sample of Covered Services You pay (after copay if applicable): In-network Out-of-network Eye Exams $0 Amount over $59 Single Vision Lenses $0 Amount over $30 Lined Bifocal Lenses $0 Amount over $50 Lined Trifocal Lenses $0 Amount over $65 Lenticular Lenses $0 Amount over $100 Frames 80% of amount over $130¹ Amount over $70 Costco, Walmart and Sam's Club Frame Allowance Amount over $70 Contact Lenses (Elective) Amount over $130 Amount over $120 Contact Lenses (Medically Necessary) $0 Amount over $210 Contact Lenses (Evaluation and fitting) 15% off UCR No discounts Cosmetic Extras Avg. 20-25% off retail price No discounts Glasses (Additional pair of frames and lenses) 20% off retail price** No discounts Laser Correction Surgery Discount Up to 15% off the usual charge or 5% off promotional price No discounts Service Frequencies Exams Every calendar year Lenses (for glasses or contact lenses)‡‡ Every calendar year Frames Every two calendar years‡‡‡ Network discounts (glasses and contact lens professional service) Limitless within 12 months of exam. Dependent Age Limits 26 To Find a Provider: Register at VSP.com to find a participating provider. VSP • Additional Features Benefits: Safety Glass Rider • ‡‡Benefit includes coverage for glasses or contact lenses, not both. • ** For the discount to apply your purchase must be made within 12 months of the eye exam. 8
Your vision coverage GUARDIAN® is a registered trademark of The Guardian Life Insurance Companyof America Aesop IntermediateLLC Kit created 12/05/2022 ALL ELIGIBLE EMPLOYEES Groupnumber:00554984 • Charges for an initial purchase can be used toward the material allowance. Any unused balance remaining after the initial purchase cannot be banked for future use. The only exception would be if a member purchases contact lenses from an out of network provider, members can use the balance towards additional contact lenses within the same benefit period. • 1Extra $20 on select brands • Members can use their in network benefits on line at Eyeconic.com. • ‡‡‡.The VSP system considers contact lenses to be the equivalent of a full pair of eyeglasses (lenses and frames) so while the member can obtain contact lenses one year and standard eyeglass lenses the next year, the frames benefit would not be available until 24 months or two calendar years, depending on the plan design, after the date the member obtained the contact lenses. • In Network Routine Retinal Screening Covered after no more than a $39 copay. EXCLUSIONS AND LIMITATIONS Important Information: This policy provides vision care limited benefits health insurance only. It does not provide basic hospital, basic medical or major medical insurance as defined by the New York State Insurance Department. Coverage is limited to those charges that are necessary for a routine vision examination. Co-pays apply. The plan does not pay for: orthoptics or vision training and any associated supplemental testing; medical or surgical treatment of the eye; and eye examination or corrective eyewear required by an employer as a condition of employment; replacement of lenses and frames that are furnished under this plan, which are lost or broken (except at normal intervals when services are otherwise available or a warranty exists). The plan limits benefits for blended lenses, oversized lenses, photochromic lenses, tinted lenses, progressive multifocal lenses, coated or laminated lenses, a frame that exceeds plan allowance, cosmetic lenses; U-V protected lenses and optional cosmetic processes. The services, exclusions and limitations listed above do not constitute a contract and are a summary only. The Guardian plan documents are the final arbiter of coverage. Contract #GP-1-VSN-96-VIS et al. Laser Correction Surgery: Discounts on average of 10-20% off usual and customary charge or 5% off promotional price for vision laser Surgery. Members out-of-pocket costs are limited to $1,800 per eye for LASIK or $1,500 per eye for PRK or $2300 per eye for Custom LASIK, Custom PRK, or Bladeless LASIK. Laser surgery is not an insured benefit. The surgery is available at a discounted fee. The covered person must pay the entire discounted fee. In addition, the laser surgery discount may not be available in all states. Guardian’s Vision Insurance is underwritten and issued by The Guardian Life Insurance Company of America, New York, NY. Products are not available in all states. Policy limitations and exclusions apply. Optional riders and/or features may incur additional costs. This policy provides vision care limited benefits health insurance only. It does NOT provide basic hospital, basic medical or major medical insurance as defined by the New York State Department of Financial Services. Plan documents are the final arbiter of coverage. Policy Form # GP-1-GVSN-17 9
