	STANDARD PLAN	HIGH PLAN

YOU SELECTED

OUT-OF-POCKET WITHOUT VSP

WITH VSP

PREMIER PROGRAM PRACTICES

WITH VSP

PREMIER PROGRAM PRACTICES

Comprehensive
Eye Exam

${{examOOP}}

${{standardExamVSP}}

${{standardPremierExamVSP}}

${{highExamVSP}}

${{highPremierExamVSP}}

Retinal Screening

${{retinalOOP}}

${{standardRetinalVSP}}

${{standardPremierRetinalVSP}}

${{highRetinalVSP}}

${{highPremierRetinalVSP}}

Materials Copay

${{materialsCopayOOP}}

${{standardMaterialsCopay}}

${{standardPremierMaterialsCopay}}

${{highMaterialsCopay}}

${{highPremierMaterialsCopay}}

Lens Type

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${{lensOOP}}

${{standardLensVSP}}

${{standardPremierLensVSP}}

${{highLensVSP}}

${{highPremierLensVSP}}

Lens Materials

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${{materialsOOP}}

${{standardMaterialsVSP}}

${{standardPremierMaterialsVSP}}

${{highMaterialsVSP}}

${{highPremierMaterialsVSP}}

Lens Enhancements

Anti-glare coating***

${{antiOOP}}

${{standardAntiVSP}}

${{standardPremierAntiVSP}}

${{highAntiVSP}}

${{highPremierAntiVSP}}

Light-reactive

${{lightOOP}}

${{standardLightVSP}}

${{standardPremierLightVSP}}

${{highLightVSP}}

${{highPremierLightVSP}}

Scratch-resistant

${{scratchOOP}}

${{standardScratchVSP}}

${{standardPremierScratchVSP}}

${{highScratchVSP}}

${{highPremierScratchVSP}}

UV Protection

${{uvOOP}}

${{standarduvVSP}}

${{standardPremieruvVSP}}

${{highuvVSP}}

${{highPremieruvVSP}}

Frames {{frameOptions}}

${{framesOOP}}

${{standardFramesVSP}}

${{standardPremierFramesVSP}}

${{highFramesVSP}}

${{highPremierFramesVSP}}

Total*

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${{standardTotal}}

${{standardPremierTotal}}

${{highTotal}}

${{highPremierTotal}}

PRINT RESULTS RETAKE QUIZ

Anti-glare: ${{antiVSP}}

Light-Reactive: ${{lightVSP}}

Scratch-resistant: ${{scratchVSP}}

UV Protection: ${{uvVSP}}

None: ${{noneVSP}}

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VSP, Eyeconic, and WellVision Exam are registered trademarks and VSP's Eye on Cost Calculator is a trademark of Vision Service Plan. In the event of a conflict between this information and your organization's contract with VSP, the terms of the contract will prevail. Based on applicable laws, benefits may vary by location. In the state of Washington, VSP Vision Care, Inc., is the legal name of the corporation through which VSP does business. Out-of-pocket cost estimates are based on averages and usual & customary charges, subject to change.

*This tool gives an estimate only, it does not guarantee that you will be eligible for benefits or a specific amount of benefits. Out-of-pocket cost estimates are based on average and usual & customary changes when a member uses a VSP Network Provider and are subject to change. The actual price you pay may be higher or lower than this estimate based on your unique circumstances and the provider you see. Please contact your VSP Network Provider for exact out-of-pocket costs.

**Brands are subject to change. (Frame allowance can be used on any frame from Visionworks).

***TechShield^® anti-glare coating is covered-in-full with the High Option Plan, other types of anti-glare coatings may increase your out-of-pocket total.