Idaho State University

Vision Benefits
Vision Services Plan
1-800-877-7195 www.vsp.com

Effective July 1, 2012

Professional Fees

• Eye Exam, up to

$ 50.00

Materials—lenses per pair

• Single vision, up to
• Bifocal, up to
• Trifocal, up to
• Lenticular, up to
• Frame, up to

$ 50.00
$ 80.00
$ 95.00
$125.00
$ 50.00

Contact Lenses—per pair (evaluation, materials and fittings only)

• Elective, up to
• Medically Necessary, up to

$ 70.00
$125.00

Service Frequency Limitations

• Insured may receive one eye exam every twelve months
• Insured may receive one pair of spectacle lenses or contact lenses every twelve months
• Insured may receive one frame every twenty-four months

VSP Provider Benefit:
20% discount on complete pair of prescription glasses and/or 15% discount on doctor’s professional services (exams associated with contact lenses) if your doctor is a VSP provider.  Your VSP provider will submit billing for you.