VISION BENEFITS
To help you take care of your eyesight , The Suquamish Tribe provides vision care coverage through Ameritas on the Vision Service Plan ( VSP ) network . You can access vision care services from any provider you wish . However , your costs will typically be lower if you choose a VSP network provider . You will not receive a VSP identification card – simply let your provider know you are a VSP member when you make your appointment . You can find VSP providers online . Please see the information in “ Your Benefits Contacts ” toward the back of this Guide .
In-Network
Out-of-Network Reimbursed
Routine Exam $ 10 per visit Up to $ 50 *
Materials Copay $ 25 copay $ 25 copay
Lenses Single Vision No charge * Up to $ 50 * Lined Bifocals No charge * Up to $ 75 * Lined Trifocals No charge * Up to $ 100 * Frames $ 130 then 20 % discount * Up to $ 70 *
Contact Lenses ( in lieu of eyeglasses )
Fitting and Evaluation Up to $ 60 copay after 15 % discount N / A
Elective Contacts $ 130 allowance * Up to $ 105 for materials *
Frequency ( Exam / Lenses / Frames / Contacts )
12 / 12 / 24 / 12 months
* Less any applicable copay
If you purchase oversize lenses or have anything “ special ” done to your lenses ( i . e ., tinting , scratch guard , etc .), you will be responsible for this cost .
IMPORTANT
Members receive a 35-40 % discount off non-covered lens options when services are received from a VSP network provider .
Discuss your lens options with your provider to determine whether or not you want to continue with their recommendations for lens options based on your out-of-pocket cost .
Prepared by Gallagher for the Employees of The Suquamish Tribe 16