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California State University, Long BeachCalifornia State University, Long Beach

Vision Care Summary

Our group vision care plan is offered to all eligible employees and their eligible dependents. As of January 1, 2007, Vision Service Plan (VSP) will administer the employer-paid vision benefits and all service claims.

To receive the full plan benefits you must obtain services from a participating provider. You may obtain services from a non-participating provider, however, at a reduced benefit. To view a list of participating VSP Doctors go to www.vsp.com or call 800-877-7195.

Item Basic Benefits
Co-payment $10.00, payable at the time of service.
Comprehensive Examination Once every calendar year.
Lenses

One pair every other calendar year or every year if a prescription change (as defined in the Group Master Policy) is indicated.

Single vision, lined bifocal and lined trifocal lenses.

Polycarbonate lenses for dependent children.

Frames One frame every other calendar year.
Lens Enhancements Every other calendar year.
Contacts
(instead of glasses)
Every other calendar year.
Contact Lenses

Medically necessary contact lenses when required for anisometropia or keratoconus, or following cataract surgery, or when visual acuity cannot be corrected to 20/70 in the better eye, except through the use of contacts.

One pair of contact lenses for cosmetic reasons when provided in lieu of other eyewear once every other calendar year or every year if a prescription change (as defined in the Group Master Policy) is indicated.

Video Display Terminal (VDT) Benefit

All active employees who utilize a video display terminal for at least 4 hours per day on a regular basis as provided in their CSU job description shall be eligible for the VDT program as follows:

Item Benefit

Co-payment

$10.00 payable at the time of examination. This deductible is separate from the Basic Benefit co-payment.

Supplemental Examination

Provider shall perform additional tests during the examination to determine visual needs in relation to the use of a VDT.

Lenses

Lenses One pair once every other calendar year or every calendar year if a prescription change (as defined by the Group Master Policy) is indicated.

Frames

New frames will be provided once every other calendar year.

Examination

Service Participating Provider Non-Participating Provider
Comprehensive Opthalmologic Covered $50.00
Comprehensive Optometric Covered $50.00

Frames & Lenses

Product Participating Provider Non-Participating Provider
Frame

$95.00
on wide selection

$115.00
on featured frame brands

20% savings on amount over allowance

Up to $60.00
Single Vision Lenses Covered Up to $45.00
Lined Bifocal Lenses Covered Up to $65.00
Lined Trifocal Lenses Covered Up to $85.00
Lens Enhancements

$55.00 standard progressive

$95.00-$105.00 premium progressive

Not Covered
Aspheric Monofocal Covered Up to $125.00
Aspheric Multifocal Covered Up to $125.00
Lenticular Monofocal Covered Up to $125.00
Lenticular Multifocal Covered Up to $125.00
Contact Lenses- Cosmetic $120.00 Up to $110.00
Contact Lenses- Medically Necessary $250.00 Up to $250.00

Extra Discounts and Savings

Laser Vision Correction

Average 15% off the regular price or 5% off the promotional price; discounts only available from contracted centers.

Contact Lens

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

Glasses and Sunglasses

Extra $20 to spend on featured frame brands. Go to vsp.com/specialoffers for details.

20% savings on additional glasses and sunglasses, including lens enhancements, from any VSP provider within 12 months of the last WellVision Exam.