Description of Benefits
Vision Benefits
Member Services Member Pays
$20 co-pay for all vision services
Eye Examination (one every 12 months) 100% Covered
Lenses  
Single Vision (one every 12 months) 100% Covered
up to plan allowance
Bifocal (one every 12 months) 100% Covered
up to plan allowance
Trifocal (one every 12 months) 100% Covered
up to plan allowance
Lenticular (one every 12 months) 100% Covered

Tint #1 (one every 12 months)
Any color, plastic lenses only

100% Covered
Frames* (one every 24 months)
($60.00 Retail Frame Allowance)
* The employees will pay the additional charges if they select frames costing more than the plan allows.		 100% Covered
up to plan allowance
Contact Lenses
Cosmetic Contact Lenses are available in addition to your basic benefit (see schedule of extras); or, if desired in lieu of all other services, $100 applies to the Doctor's Customary Package Fee.
Medically Necessary Contact Lenses are available each 24 months as needed. This is a $250 benefit which includes: a special contact lens examination, follow up visits and Medically Necessary Lenses.
Dental Benefits
Office Visit No Charge
X-Rays No Charge
Cleaning
(child or adult)		 No Charge
Fluoride
(to age 14) 		No Charge
1 Surface Amalgam $2.00
Bi Rooted Canal $90.00
(without restoration)
Crown (porcelain) $105.00
Orthodontia Covered
Specialty Care Limited Coverage
LASIK Benefits

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.
Many additional services are available at reduced fees on our schedule of extras and Complete Dental Benefits ..

Rates
Dental: No Annual Deductible
Vision: $20 Annual Deductible/Person
Employee $21.00/month
Employee +1 $36.75/month
Family $52.22/month
These rates offer a 2 year guarantee and are effective for Vluntary or Employer Paid Groups.