Description of Benefits
Member Services Member Pays
Preventative Eye Care Analysis No Charge
Cataract Analysis

No Charge

Glaucoma Test (IOP Measurement) No Charge
Frame Repairs
(screw, nosepad replacement)		 No Charge
Frame Adjustments No Charge
Tint #1
(solid color, plastic lenses)		 No Charge
Computerized Vision Analysis
(where available) 		No Charge
Frames 25% Off Normal Retail Price
Refraction
Determines Eyeglass Prescription
Co-payment must be paid directly to the doctor at the time of service. These benefits are part of and used in conjunction with your HMO package. 		$36
Lenses
Lenses with power over +/- 6.00 D SPH or when combined with +/- 2.00 D CYL may have additional charges. Any multifocal add of +3.25 or more may be charged an additional laboratory fee. SEGS larger than 28mm may be charged an additional laboratory fee.
Single Vision Lenses $42
Bifocal Lenses
(Rnd. 22 - FT 25-28) 		$55
Trifocal
(FT 7x22)		 $79
Progressive (Generic) $139
Progressive (Premium) 20% Off UCR
Lenticular Lenses (S.V.) $180
Lenticular Lenses (B.F.) $240
Lens Extras
Oversize (over 58mm E.D.) $15
Fashion Tints: Single Gradient
Fashion Tints: Double Gradient		 $15
$25
   
Photoxtra (Single Vision) 20% Off UCR
Photoxtra (Bifocal) 20% Off UCR
Photoxtra (Progressive) 20% Off UCR
Photochromic
(i.e. transitions, sun sensor, etc.)
 20% Off
Scratcote (Plastic lenses) $20
Polycarbonate $39
Thin Lens (other than Polycarbonate) 20% Off UCR
UV Coating $10
Rimless (Edge Groove or Drill Mount) 20% Off UCR
Prism $4 per Diopter
Contact Lenses (ALL LENS PRICING, PER PAIR)
When purchasing contact lenses, you may receive a contact lens evaluation and fitting in addition to a refraction.
Contact Lens Evaluation + Fitting 25% Off UCR
Contact Lens Service Agreement Normal Retail Price
Contact Lens Care Kits Normal Retail Price
Additional Contact Lens Visits $10 Each
Hard Lenses (PMMA) $85
Gas Permeable (RCP Sphere) $145
Soft (Daily):  
Bausch & Lomb (or similar) $90
Cooper (or similar) $99
Soft (Extended Wear):  
Bausch & Lomb (or similar) $90
Ciba (or similar)
 $99
Toric Contact Lenses:  
Soft/Hard/R.G.P. 20% Off UCR
Soft Custom Colors 20% Off UCR
Disposable (1st 3 months supply only) 10% Off UCR

Custom Contacts
Contact lens powers over
+/- 6.25 D SPH and/or
+/- 2.0 D CYL (combined) are considered
custom and will be charged extra.
MEDICALLY NECESSARY CONTACT LENSES
MAY BE CONSIDERED CUSTOM, HOWEVER
REQUIRE PRIOR AUTHORIZATION
(Orthokeratology not covered)

 20% Off
Multifocal Contact Lenses
(Soft disposable 1st 3 months supply only)		 10% Off
LASIK Benefit

Vision Plan of America is now providing members ACCESS TO a Laser Vision Correction preferred pricing plan! The Qualsight Preferred Pricing Program offers an enhancement to your VPA plan including:

  • Savings – you can now save 40-55% off the overall national average charge for LASIK!
  • Experienced Physicians – national access to credentialed, Board Certified Ophthalmologists who use state-of-the-art, FDA approved LASIK equipment
  • Convenience – our Care Managers provide a thorough prescreening process along with education about LASIK technologies, cost and benefits
  • Financing – flexible financing available to qualified candidates.

To Access Preferred Pricing Call: 877 507 4448
Hours: 7 am - 9 pm (CST) Weekdays; 10 - 5 pm Saturdays
www.Qualsight.us

The Qualight program is not an insured benefit. Vision Plan of America makes access to the Qualsight Program available to its members for preferred pricing FOR LASIK surgery. Vision Plan of America makes no specific recommendation for or against the Plan. All representations are those Qualsight.