CSU Vision
Program
A 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.
Monthly Premium
Currently, this benefit is provided at no cost to the employee; the full monthly premium is paid by the CSU. However, premium costs are subject to change.
Eligibility
Employees are eligible if appointed half-time or more for a period of more than six (6) months.
Lecturers and Coaches appointed for a minimum of one semester or two consecutive quarters at .4 timebase or greater are eligible for benefits. Coaches and Lecturers (Non-academic calendar year) are eligible for benefits if appointed half-time or more for a period of more than six (6) months. Click here to view faculty benefits eligibility details.
Employees appointed on an hourly, intermittent basis do not qualify for benefits.
Enrollment
All eligible employees will be automatically enrolled for self and eligible family members. Eligible family members include your legal spouse and dependent children who are age 23 and under.
Effective Date
Plan services cannot be obtained until the deduction description "VISION-VSP" appears on your pay warrant stub; generally the second pay warrant issued for your qualifying appointment.
How to use the Plan
No ID cards. No claim forms.
- Find a VSP network doctor at vsp.com or call 800-877-7195.
T.D.D. number for the hearing impaired is 800-428-4833. - Make an appointment and tell the doctor you are a VSP member.
- Your doctor and VSP will handle the rest.
If you elect to use a non-VSP provider you must submit an itemized receipt to VSP in order to receive reimbursement based on the out-of-network allowances.
- View a list of VSP Participating Doctors.
- Download a list of VSP Participating Doctors.
A claim form, however, is still required for VDT benefits whether using a VSP Select Network doctor or non-VSP Provider. Employees must meet the CSU requirements to be eligible for VDT coverage and obtain the form from Benefits Services (Brotman Hall 358).
Vision Care Benefits
To receive the full plan benefits you must obtain services from a participating provider. A list of participating providers is available to view in Benefits Services (Brotman Hall 358). You may obtain services from a non-participating provider, however, at a reduced benefit.
| 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. |
| Frames: | One frame 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. |
Low Vision Benefit
The Low Vision Benefit is available for severe visual problems that are not correctable with regular lenses, subject to the following limitations: 1) Prior Authorization, 2) 25% co-payment, 3) Maximum Benefit - $1,000 (excluding co-payment) every 2 years for approved Low Vision care.
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. |
Extra Discounts and Savings
Laser Vision Correction
Savings averaging 15% off laser vision correction surgery (PRK, LASIK and Custom LASIK) through VSP contracted center.
Contact Lens
15% off cost of contact lens exam (fitting and evaluation).
Exclusions
-
Orthoptics or vision training, subnormal vision aids (except as authorized under the Low Vision Benefit) or non-prescription lenses;
-
Coated lenses, no-line bifocal (blended type) lenses or oversized lenses exceeding the Allowable Amount;
-
Replacement or repair of lost or broken lenses or frames except at the normal intervals;
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Eye examination required by an employer as a condition of employment;
-
Medical or surgical treatment of the eyes;
-
Contact lenses, except as specifically provided; or
-
Conditions covered by Workers' Compensation law.
Schedule of Allowances
The allowable amount depends on whether you obtain services from a participating or non-participating provider.
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 |
|---|---|---|
| Single Vision Lenses | Covered | Up to $45.00 |
| Bifocal Lenses | Covered | Up to $65.00 |
| Trifocal Lenses | Covered | Up to $85.00 |
| 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 |
| Frame | $95.00 | Up to $60.00 |
| Contact Lenses- Cosmetic | $120.00 | Up to $110.00 |
| Contact Lenses- Medically Necessary | $250.00 | Up to $250.00 |
Continuation of Group Coverage
In accordance with the Consolidated Omnibus Budget Reconciliation Act (COBRA), you are entitled to continue group coverage under this Certificate if you would lose coverage otherwise because of a Qualifying Event that occurs while the Group Policyholder is subject to the continuation coverage provisions of COBRA.
For further information, please contact Benefits Services at (562) 985 – 2120.