Retiree Health and Welfare Benefit Summaries

The Vision Plan is available to all active and retired members and their eligible dependents, except for those enrolled in the COBRA Core Plan, Plan M, and Medicare Retirees in a Medicare Advantage Plan.

This benefit helps pay for annual vision examinations and for glasses and contact lenses, subject to the rules of the Plan. The Plan uses a network of opticians, optometrists, and ophthalmologists called Vision Service Plan (VSP) to provide these benefits in an efficient and cost-effective way. Reduced benefits are available when you use a provider outside the VSP network. How often you can use the benefit and your copayment are shown in the benefit schedule below.

Benefit	Frequency	Your Copayment
Eye Examinations	once every 12 months	$15
Lenses	once every 24months if needed	$25 (for both lenses and frames)
Frames	once every 24 months if needed
Lenses – Second Pair Benefit	once every 24months if needed	$60 (for both lenses and frames)
Frames – Second Pair Benefit	once every 24 months if needed
Contacts (can be chosen instead of lenses and frames)	12 months	$10

Benefit	Frequency	Plan Pays (you pay entire remainder)
Eye Exam	once every 12 months	up to $40
Lenses	once every 24 months if needed	up to $40/single vision up to $60/bifocal up to $80/trifocal up to $125/lenticular
Frames	once every 24 months if needed	up to $70 contact lenses (elective) – $105
Contacts	Necessary	$250
	Elective	$150

Website:  www.vsp.com
Phone Number: 1-800-877-7195
Monday – Friday 5 a.m. to 8 p.m., Pacific Time
Saturday 7 a.m. to 8 p.m., Pacific Time
Sunday 7 a.m. to 8 p.m., Pacific Time

Closed: Major Holidays

Hearing impaired customers may call 800.428.4833 for assistance.