|
 |
| 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. |
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