VSP and You Self-Service in The Well
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Select type of Quiz
VSP General Quiz
VSP LightCare™ Quiz
VSP Buy-Up Quiz
VSP Buy-Up with EasyOptions Quiz
Client Name
Client Name is required
Annual Savings amount
$
CSW link or OE portal link
Open enrollment end date
OE Contact Information
Exam copay
$
Exam frequency (select one):
Every plan year
Every calendar year
Every 12 months
Every 24 months
Every other plan year
Every other calendar year
Prescription glasses copay
$
Prescription glasses frequency (Select one):
Every plan year
Every calendar year
Every 12 months
Every 24 months
Every other plan year
Every other calendar year
Frame allowance dollar amount
$
Contact lens allowance dollar amount
$
Contact lens frequency
Every plan year
Every calendar year
Every 12 months
Every 24 months
Every other plan year
Every other calendar year
Basic Plan Name
Buy-Up Plan Name
Buy-Up Exam Copay
$
BU Plan Exam Frequency (Select one):
Every plan year
Every calendar year
Every 12 months
Every 24 months
Every other plan year
Every other calendar year
BU Plan Frame Allowance Dollar Amount
$
BU Plan Frame Frequency (select one):
Every plan year
Every calendar year
Every 12 months
Every 24 months
Every other plan year
Every other calendar year
Featured Frame Allowance (select one):
Extra $20
Additional $50
Buy Up Contact Lens Allowance Dollar Amount
$
Buy Up Contacts Frequency (Select one):
Every plan year
Every calendar year
Every 12 months
Every 24 months
Every other plan year
Every other calendar year
EasyOptions Frame Upgrade: An additional
$xxx
frame allowance
$
EasyOptions Contacts Upgrade: An additional
$xxx
contact allowance
$
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