What's Covered

MMC Benefits Handbook

What's Covered

The table below summarizes the Plan's coverage levels.

Vision Care Plan	Low (Standard) Option		High (Enhanced) Option
Coverage for In-Network Providers
Eye Examination	Covered in full, after a $10 copayment, every calendar year		Covered in full, after a $10 copayment, every calendar year
Lenses Single Vision Lined Bifocal Lined Trifocal Polycarbonate (for children up to age 26)	Covered in full, after a $25 copayment, every calendar year		Covered in full, after a $10 copayment, every calendar year
Progressive Lenses	Standard Progressive $0 copayment Premium Progressive $95-$105 copayment Custom Progressive $150-$175 copayment		Standard Progressive $0 copayment Premium Progressive $95-$105 copayment Custom Progressive $150-$175 copayment
Frames	Covered up to $150, every other calendar year, with a 20% savings on the amounts over the retail allowance		Covered up to $200, every calendar year, with a 20% savings on the amounts over the retail allowance
Contact Lenses (in lieu of Lenses and Frame)	Covered up to $150, every calendar year, contact lens exam (fitting and evaluation) covered in full with a copayment not to exceed $60. VSP has partnered with leading contact lens manufacturers to provide VSP members exclusive offers. Visit www.specialoffers.vsp.com to learn more.		Covered up to $200, every calendar year, contact lens exam (fitting and evaluation) covered in full with a copayment not to exceed $60. VSP has partnered with leading contact lens manufacturers to provide VSP members exclusive offers. Visit www.specialoffers.vsp.com to learn more.
Medically Necessary Contact Lenses (in lieu of Lenses and Frame) [requires VSP approval]	Covered in full after a $25 copay every calendar year No copay required for contact lens exam (fitting and evaluation)		Covered in full after a $10 copay every calendar year No copay required for contact lens exam (fitting and evaluation)
UV Coating	Up to a 30% savings off the retail price		Up to a 30% savings off the retail price
Tint (Solid and Gradient)	Up to a 30% savings off the retail price		Up to a 30% savings off the retail price
Scratch Resistance	Up to a 30% savings off the retail price		Up to a 30% savings off the retail price
Basic Polycarbonate (for adults over age 26)	Up to a 30% savings off the retail price		Up to a 30% savings off the retail price
Standard Anti-Reflective	Up to a 30% savings off the retail price		Up to a 30% savings off the retail price
Laser Vision Correction (PRK, LASIK and Custom LASIK)	Savings average 15% off the regular price or 5% off the promotional price. Discounts only available from contracted facilities.		Savings average 15% off the regular price or 5% off the promotional price. Discounts only available from contracted facilities.
Additional Pairs of Prescription Glasses	20% savings on additional glasses and sunglasses, including lens enhancements, from any VSP doctor within 12 months of your last WellVision Exam.		20% savings on additional glasses and sunglasses, including lens enhancements, from any VSP doctor within 12 months of your last WellVision Exam.
Replacement Contact Lenses	15% off the contact lens exam (discount does not apply to the contact lens materials)		15% off the contact lens exam (discount does not apply to the contact lens materials)
Mail Order Contact Lenses	Convenient home or office delivery options may be available from your VSP doctor.		Convenient home or office delivery options may be available from your VSP doctor.
Coverage for Out-of-Network Providers
Eye Examination		Up to a $45 allowance	Up to a $45 allowance
Lenses Single Vision Lined Bifocal Lined Trifocal		Single Vision: Up to $30 allowance Lined Bifocal : Up to $50 allowance Lined Trifocal Lenses: Up to $65 allowance Progressive Lenses : Up to $50 allowance	Single Vision: Up to $30 allowance Lined Bifocal : Up to $50 allowance Lined Trifocal Lenses: Up to $65 allowance Progressive Lenses : Up to $50 allowance
Frames		Up to $70 allowance	Up to $70 allowance
Contact Lenses (in lieu of Lenses and Frame)		Up to $105 allowance	Up to $105 allowance
Medically Necessary Contact Lenses		Up to $210 allowance	Up to $210 allowance