Payroll Services Vision Plan - MBO Partners

VSP is the largest vision insurance company in the US with the largest independent doctor network.

	VSP BASE VISION PLAN COST (MONTHLY)	VSP BUY-UP COST (MONTHLY)
Member	$7.50	$13.11
Member +1	$12.63	$22.08
Member + Children	$12.90	$22.54
Member + Family	$20.79	$36.34

BENEFIT DESCRIPTION	VSP BASE VISION PLAN		VSP BUY-UP VISION PLAN
	IN-NETWORK	OUT-OF-NETWORK REIMBURSEMENT	IN-NETWORK	OUT-OF-NETWORK REIMBURSEMENT
Vision Exam (Once Every 12 months)	$10 Copay	Up to $45	$10 Copay	Up to $45
Materials	$10 Copay	N/A	$10 Copay	N/A
Lenses (Once Every 12 Months) Single Bifocal Trifocal Progressives	$10 Copay $10 Copay $10 Copay $10 Copay	Up to $30 Up to $50 Up to $65 Up to $50	$10 Copay $10 Copay $10 Copay $10 Copay	Up to $30 Up to $50 Up to $65 Up to $50
Frames (Once Every 24 months)	$130 allowance, 20% Off Remaining Balance	Up to $70	$200 allowance, 20% Off Remaining Balance	Up to $70
Contacts Lens Exam (fitting and evaluation)	$60 Copay	N/A	$60 Copay	N/A
Contact Lenses (Once every 12 Months) Necessary Elective	$10 Copay $120 Allowance	Up to $105 Up to $105	$10 Copay $130 Allowance	Up to $105 Up to $105

*See VSP Vision Member Benefits Summary for a full list of included services

Extra $20 to spend on featured frame brands. 20% savings on additional glasses and sunglasses, including lens enhancements, from the same VSP provider within 12 months of your last WellVision exam.

No more than a $39 copay on routine retinal screening as an enhancement to a WellVision Exam

Average 15% off the regular price; discounts only available from contracted facilities

User ID: Your 9-digit Social Security Number (without dashes or spaces)
PIN: Last four digits of your Social Security Number and the last two digits of your birth year

Call Steele Benefits at 812-955-0230 to speak with a benefit counselor Monday - Friday 8:30 a.m. to 5 p.m. ET.

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