Description of Benefits
After a $20 Co-Pay
Benefit Frequency Member Pays
Eye Examination Every 12 Months 100% Covered
Lenses    
Single Vision Every 12 Months

100% Covered

Bifocal Every 12 Months 100% Covered
Trifocal Every 12 Months 100% Covered
Lenticular Every 12 Months 100% Covered
Tint #1
Any color, plastic lenses only 		Every 12 Months 100% Covered
Frames*
($100.00 Retail Frame Allowance)
* The enrollees will pay the additional charges if they select frames costing more than the plan allows 		Every 12 Months 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.

Option1: Receive basic services (eye examination, refraction, eyeglass lenses and frame) and receive the co-payment (if any) for eye examination and any extras for the eye glasses. Members are eligible for contact lens services under the Schedule of Extras.

OR

If the member wishes Contact Lenses in lieu of Glasses

Option 2: “Contact Lenses in lieu of Basic Benefit”: After the member pays the Co-payment (if any), they receive a $100.00 credit towards the doctors Usual and Customary Package for Exam (refraction), Fitting, and Contact Lenses.
 
Example: (after co-payment)

Exam = $75.00 +
Fitting = $75.00 +
Contact Lenses = $150.00
Total Package = $300.00 –
C.L. Benefit = $100.00
Member Pays = $200.00
Many additional services are available at reduced fees on our schedule of extras.
Medically Necessary Contact Lenses are available each 12 months if a change is indicated. A $75 co-payment is paid by the member to the provider which includes: A special contact lens examination, follow-up visits and medically necessary contact lenses. This is a $250 benefit.
Dental Benefits (Plan 495)
Benefits Member Pays
Examination No Charge
Office Visit No Charge
X-rays (full set & single) No Charge
Flouride (up to age 14) No Charge
Bi-rooted Canal $45 co-pay
without restoration
Amalgam (one surface) $2 co-pay
Full Banded Ortho (for children) $1,775
Full Branded Ortho (for adults) $1,975
Many additional services are available at reduced fees on our schedule of extras.
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.
Many additional services are available at reduced fees on our schedule of extras.

Rates *

Individual Only: $24.00/month
Individual + 1: $42.00/month
Individual + 2 or more $59.00/month

 
*The Emerald Plan is a 12 month contract. Once the benefits have been utilized, the member must remain enrolled to the end of the contract.