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| Description of Benefits | |
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| Vision Benefits | |
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| Member Services | Member Pays |
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| $20 co-pay for all vision services | |
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| Eye Examination (one every 12 months) | 100% Covered |
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| Lenses | |
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| Single Vision (one every 12 months) | 100% Covered up to plan allowance |
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| Bifocal (one every 12 months) | 100% Covered up to plan allowance |
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| Trifocal (one every 12 months) | 100% Covered up to plan allowance |
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| Lenticular (one every 12 months) | 100% Covered |
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Tint #1 (one every 12 months) |
100% Covered |
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| 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 |
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| Contact Lenses | |
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| 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. | |
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| 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. | |
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| Dental Benefits | |
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| Office Visit | No Charge |
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| X-Rays | No Charge |
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| Cleaning (child or adult) |
No Charge |
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| Fluoride (to age 14) |
No Charge |
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| 1 Surface Amalgam | $2.00 |
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| Bi Rooted Canal | $90.00 (without restoration) |
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| Crown (porcelain) | $105.00 |
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| Orthodontia | Covered |
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| Specialty Care | Limited Coverage |
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| LASIK Benefits | |
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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:
To Access Preferred Pricing Call: 877 507 4448 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. |
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Many additional services are available at reduced fees on our schedule of extras and Complete Dental Benefits  .. |
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Rates |
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| Dental: No Annual Deductible Vision: $20 Annual Deductible/Person |
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| Employee | $21.00/month |
| Employee +1 | $36.75/month |
| Family | $52.22/month |
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| These rates offer a 2 year guarantee and are effective for Vluntary or Employer Paid Groups. | |
QualSight Preferred
LASIK Pricing
