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
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Coverage from a VSP Select Network Doctor |
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Exam |
every calendar year |
Covered in full with a $10 copay |
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Prescription Glasses: |
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every other calendar year |
Covered in full |
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every other calendar year |
Frame of your choice covered up to $95 retail. |
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or |
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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.
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VDT Supplemental Benefit |
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Exam |
every calendar year |
Covered in full with a $10 copay |
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Lenses |
every other calendar year |
Covered in full |
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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.
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Out-of-Network Reimbursement Amounts |
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Exam: Routine and VDT |
Up to $50 |
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Lenses: |
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Single Vision: Routine and VDT |
Up to $45 |
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Lined Bifocal: Routine and VDT |
Up to $65 |
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Lined Trifocal: Routine and VDT |
Up to $85 |
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Polycarbonate for dependent children |
Up to $65 |
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Lenticular and Aphakic |
Up to $125 |
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Frame: Routine and VDT |
Up to $60 |
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Elective Contacts |
Up to $110 |
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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.



