VISION BENEFITS

All eligible employees are automatically enrolled in the vision insurance plan.  The premiums are paid by the CSU.  Vision Service Plan (VSP) provides the administration of vision benefits and claims on behalf of the employer-paid California State University (CSU) Vision Plan.

CSU Group Policy Number: 12292796
Customer Service: (800) 877-7195

LINKS:

Website: www.vsp.com
Evidence of Coverage Booklet
VSP Out-of-Network Reimbursement Form
VSP Video Display Terminal Confirmation Form

Vision Benefits Summary

Coverage from a VSP Select Network Doctor

Exam

every calendar year

Covered in full with a $10 copay

Prescription Glasses:

   

Lenses

every other calendar year

Covered in full

Frames

every other calendar year

Frame of your choice covered up to $95 retail.

or

Contact Lens Care:

every other calendar year

$120 allowance applies to the cost of your contacts and the contact lens exam. This exam is in addition to your vision exam to ensure proper fit of contacts.


VDT Coverage: 
This supplemental benefit is offered only to employees whose job requires use of a Video Display Terminal for at least four hours per day.  Employee must receive the VDT Confirmation Form from the campus Benefits Office and provide to the VSP doctor at the appointment.  Supplemental exam included which entails additional tests to determine employee’s visual needs in relation to VDT.  Single vision, lined bifocal and lined trifocal lenses covered in full.  Interim benefits apply to the lenses.  Frame covered up to $95.

VDT Supplemental Benefit

Exam

every calendar year

Covered in full with a $10 copay

Lenses

every other calendar year

Covered in full

Frames

every other calendar year

Frame of your choice covered up to $95 retail.


Out-of-Network Coverage: 
Dollar for dollar you get the best value from your VSP benefit when you visit a VSP Select Network doctor.  If you decide to see a non-VSP provider, the $10 exam copay still applies and you’ll receive a lesser benefit and typically pay more out-of-pocket.  Services and materials obtained through non-VSP providers are subject to the same limitations as services through VSP Select Network doctors.  Value-added discounts and savings are not available when members choose a non-VSP provider.  If you decide to see a provider not in the VSP Select Network, please contact VSP first at 800-877-7195.  Bills for services and materials received from a non-VSP provider should be paid in full, then a copy of the itemized receipt submitted to VSP for reimbursement up to the amounts shown.  For the VDT benefit, a copy of the VDT Confirmation Form must also be included.  

Out-of-Network Reimbursement Amounts

Exam: Routine and VDT

Up to $50

Lenses:

 

Single Vision: Routine and VDT

Up to $45

Lined Bifocal: Routine and VDT

Up to $65

Lined Trifocal: Routine and VDT

Up to $85

Polycarbonate for dependent children

Up to $65

Lenticular and Aphakic

Up to $125

Frame: Routine and VDT

Up to $60

Elective Contacts

Up to $110

Necessary Contacts

Up to $250

If there is a discrepancy between this information and the official plan documents and contracts, the official documents will always govern.