VSP VISION PLAN OPTIONS

AND

RATE SUMMARY

FOR

2019 SMALL GROUP PLANS

Single Emp/Sp Emp/Ch Family

Exam + Included in Medical Rates

Exam + $75 4.84 7.98 8.71 12.58

Exam + $100 6.20 10.24 11.17 16.13

Notes:

All Services are thru VSP and administered by VSP

This is a rider. Enrollment in VSP must match medical enrollment

Only available to Group Plans

Additional Custom Options available to Large Groups. Contact Friday Health Plans for

more information

CHOICE EXAM PLUS

Doctor Network……………………………Choice

Your Coverage from a VSP Choice Network Doctor

WellVision Exam®

focuses on your eye health and

overall wellness

$0.00 copay ........................... every 12 months

Extra Discounts and Savings

Glasses and Sunglasses

Average 20-25% savings on all non-covered lens options

20% off additional glasses and sunglasses, including lens options, from any VSP doctor within 12 months of your last WellVision Exam

Contacts

15% off cost of contact lens exam (fitting and evaluation)

Laser Vision Correction

Average 15% off the regular price or 5% off the promotional price. Discounts only available from contracted facilities.

VSP guarantees service from VSP doctors only.

Friday Health Plans and VSP provide you an affordable eyecare plan.

FRIDAY PLAN $75

Doctor Network……………………………Friday

Your Coverage from a VSP Friday Network Doctor

WellVision Exam® focuses on your eye health and overall wellness

• $0.00 copay ........................... every 12 months Prescription Glasses

• No copay applies Lenses ............................................ every 24 months

• Single vision, lined bifocal, and lined trifocal lenses

• Polycarbonate lenses for dependent children Frame ............................................. every 24 months

• $75 allowance for a wide selection of frames

• 20% off the amount over your allowance ~OR~

Contact Lens Care • No copay ............................... every 24 months

$75.00 allowance for contacts and the contact lens exam (fitting and evaluation).

Current soft contact lens wearers may qualify for a special program that includes a contact lens exam and initial supply of replacement lenses.

Extra Discounts and Savings Glasses and Sunglasses

• Average 20-25% savings on all non-covered lens options

• 20% off additional glasses and sunglasses, including lens options, from any VSP doctor within 12 months of your last WellVision Exam

Contacts

• 15% off cost of contact lens exam (fitting and evaluation)

Laser Vision Correction

• Average 15% off the regular price or 5% off the promotional price. Discounts only available from contracted facilities.

Your Coverage with Other Providers

Visit vsp.com for details, if you plan to see a provider other than a VSP doctor.

Exam ....................................................... Up to $45.00

Single vision lenses ................................ Up to $30.00

Lined bifocal lenses ................................ Up to $50.00

Lined trifocal lenses ................................ Up to $65.00

Frame ..................................................... Up to $65.00

Contacts .................................................. Up to $65.00

VSP guarantees service from VSP doctors only.

FRIDAY HEALTH PLANS MEMBERS:

Please provide Friday Health Plans ID#

Friday Health Plans and VSP provide you an affordable eyecare plan.

FRIDAY EXAM PLUS $100 ALLOWANCE PLAN

Doctor Network……………………………….….Friday

Your Coverage from a VSP Select Network Doctor

WellVision Exam® focuses on your eye health and overall wellness

• $0.00 copay ........................... every 12 months Prescription Glasses Discounts & Allowances

• No copay applies Lenses Discount ........................ every 24 months

• 20% discount when a complete pair of glasses is purchased

• Plus a total allowance of $100.00 (for lenses and frame)

Frame Discount.......................... every 24 months

• 20% discount when a complete pair of glasses is purchased

• Plus a total allowance of $100.00 (for lenses and frame)

~OR~ Contact Lens Care

No copay applies ...................... every 24 months $100.00 allowance applies to eye exam, contacts, and contact lens exam (fitting and evaluation). The contact

lens exam ensures proper fit of contacts.

Extra Discounts and Savings

Glasses and Sunglasses

• 20% off lens options like progressives and scratch-resistant and anti-reflective coatings

• 20% off additional glasses and sunglasses, including lens options*

Contacts* • 15% off cost of contact lens exam (fitting and

evaluation)

Laser Vision Correction

• Average 15% off the regular price or 5% off the promotional price from contracted facilities

* Available from any VSP doctor within 12 months of your last eye exam

Your Coverage with Other Providers

Visit vsp.com for details, if you plan to see a provider other than a VSP doctor.

Exam ....................................................... Up to $45.00

Glasses ................................................. Up to $100.00

or

Contacts ................................................ Up to $100.00

VSP guarantees service from VSP doctors only.

FRIDAY HEALTH PLANS MEMBERS:

Please provide your Friday Health Plans ID#