Vision Premiums
	Per Pay Period	Per Month
Employee	$5.22	$10.44
Employee/Spouse	$8.28	$16.56
Employee/Child(ren)	$8.45	$16.90
Family	$13.63	$27.26

Benefit Overview (if using a VSP network provider)

Eye exam…$10 co-pay, then covered in full

• one exam, per covered person, per calendar year

Lenses…$25 co-pay, then covered in full

• one pair of lenses, per covered person, per calendar year
• single vision, lined bifocal, or lined trifocal lenses included

Frames…$25 co-pay, then covered in full

• one pair of frames, per covered person, per 24 months
• $120 allowance for frames & 20% discount on amount over allowance

Contact Lenses…No co-pay

• once per calendar year, per covered person
• $105 allowance for contact lenses & contact lens exam (fitting & evaluation)

For additional information go to www.vsp.com

Questions? Contact Kimberly Kestle at 458-7168 or kkestle@pcrmc.com