Sewanee Benefits

Vision

Vision coverage helps with routine eye exams and helps offset the cost of glasses or contact lenses. This page is here to help you understand what the plan includes, how allowances and copays work, where to go for care, and what to do when you have questions about providers, claims, or out-of-network use.

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What’s included

Routine Eye Exam

The plan includes a WellVision Exam once every 12 months with a $10 copay. This routine annual exam supports both visual wellness and broader eye health.

Prescription Glasses

Prescription glasses are covered with a $25 copay. The plan includes lenses and a frame allowance, with additional savings if you select frames above the allowance amount.

Contact Lenses

If you choose contacts instead of glasses, the plan provides a contact lens allowance. The plan also includes coverage for medically necessary contacts and contact fitting or evaluation with plan-specific cost sharing.

Extra Savings and Member Tools

The plan also includes extra savings on featured frame brands, additional glasses and sunglasses through VSP providers, a routine retinal screening enhancement, and access to VSP’s website and mobile tools to find providers and review benefits.

How it works

Exam Copay
A WellVision Exam is available once every 12 months with a $10 copay.
Prescription Glasses Copay
Prescription glasses are covered with a $25 copay, and that includes standard covered lenses.
Frame Allowance
The plan includes a $130 frame allowance once every 24 months, with 20% savings on the amount over the allowance. Featured frame brands increase the allowance to $150. Costco has a separate $70 frame allowance.
Lenses
Single vision, lined bifocal, and lined trifocal lenses are covered once every 12 months and are included in the prescription glasses copay.
Covered Lens Enhancements
Impact-resistant lenses for children and standard progressive lenses are covered at $0. Other enhancements have listed copay ranges.
Contacts Instead of Glasses
If you choose contacts instead of glasses, the plan provides a $130 contact lens allowance once every 12 months. The contact lens exam and fitting is covered up to a $60 copay.
Medically Necessary Contacts
Medically necessary contacts have richer coverage than elective contacts. The out-of-network schedule includes reimbursement up to $210 for necessary contacts.
Out-of-Network Use
You can choose any provider, but the plan reimburses out-of-network care up to listed dollar amounts. In-network providers generally give you the best value and the easiest experience.

What the plan pays

In-Network
Exam: $10 copay
Prescription Glasses: $25 copay
Frames: $130 allowance; $150 featured frame allowance
Lenses: Single vision, lined bifocal, and lined trifocal included in glasses copay
Contacts: $130 allowance instead of glasses
Contact fitting exam: up to $60 copay
Out-of-Network
Exam: up to $45
Frame: up to $70
Single vision lenses: up to $30
Lined bifocal lenses: up to $50
Lined trifocal lenses: up to $65
Lenticular lenses: up to $100
Progressive lenses: up to $50
Contacts: up to $105
Necessary contacts: up to $210

Before you…

Before you schedule an eye exam
Find an in-network provider through VSP when possible.
Check whether you are due for an exam under the plan’s 12-month frequency.
Have or access your vision plan ID information before your visit.
Ask whether the office participates in the VSP Choice Network.
Before you buy glasses or contacts
Know whether you want glasses or contacts, since contacts are in lieu of glasses under the allowance.
Ask what portion of the cost is covered by the allowance and what you may owe above it.
Ask whether any lens enhancements will create extra copays.
Use your HSA or FSA for eligible out-of-pocket vision expenses if needed.
Before you pay for out-of-network care
Understand the reimbursement limits before your visit.
Keep itemized receipts and claim information.
Be prepared to submit for reimbursement if the office does not process through the network.
Contact VSP or the Benefits team if you are unsure what documentation is needed.

Common questions

Click a section below to view common questions and next steps.

Finding a provider and getting started
How do I find an in-network eye doctor?
Use VSP’s website or mobile app to find a participating provider in the VSP Choice Network.
Can I use any eye doctor?
Yes, but you usually save more by using an in-network provider. Out-of-network care is reimbursed only up to listed dollar amounts.
Where do I get my vision ID card?
Individual ID cards are not provided by VSP. Simply inform your provider that you're have VSP coverage and they can determine your coverage using your identifying information.
What if I am not sure whether I am due for an exam or hardware?
Check your member account or ask the provider to verify eligibility before the visit. Exams and lenses are generally once every 12 months, and frames are once every 24 months.
Glasses, frames, and lens enhancements
What does the $25 prescription glasses copay cover?
It covers prescription glasses and includes standard covered lenses under the plan. The frame allowance is applied separately.
How does the frame allowance work?
The plan gives you a $130 frame allowance once every 24 months. If you choose featured frame brands, the allowance increases to $150. If you choose frames above the allowance, you receive 20% savings on the amount over the allowance.
Does Costco work differently?
Yes. Costco has a separate $70 frame allowance.
What lens enhancements are covered at $0?
Impact-resistant lenses for children and standard progressive lenses are covered at $0.
What lens enhancements have extra copays?
Premium and custom progressive lenses, tints or light-reactive lenses, and scratch-resistant coating may carry additional copays. These enhancements generally include additional savings compared with standard pricing.
Contacts and medically necessary contacts
How does the contact lens benefit work?
If you choose contacts instead of glasses, the plan provides a $130 contact lens allowance once every 12 months. The contact lens exam and fitting is covered up to a $60 copay.
What does “instead of glasses” mean?
It means the elective contact allowance is used in place of the glasses benefit for that frequency period, rather than on top of it.
What are medically necessary contacts?
Medically necessary contacts are treated more generously than elective contacts when they meet the plan’s definition. The out-of-network schedule includes reimbursement up to $210 for necessary contacts.
Should I ask the office whether my contacts are elective or medically necessary?
Yes. That is an important question because it can affect how the claim is processed and how much the plan pays.
Out-of-network use and reimbursements
How does out-of-network vision coverage work?
Out-of-network vision care is reimbursed up to specific dollar amounts instead of using the full in-network structure. That means you may pay more up front and recover only part of the cost.
What are the out-of-network reimbursement amounts?
The current reimbursement amounts are up to $45 for the exam, $70 for frames, $30 for single vision lenses, $50 for lined bifocals, $65 for lined trifocals, $100 for lenticular lenses, $50 for progressive lenses, $105 for contacts, and $210 for necessary contacts.
Do I need to keep receipts if I use an out-of-network provider?
Yes. Keep itemized receipts, provider information, and any claim paperwork in case reimbursement needs to be submitted manually.
When does it still make sense to go out-of-network?
Sometimes it may still make sense if you strongly prefer a specific provider, but it is wise to compare expected cost first because reimbursement is capped.
Claims, billing, and extra savings
Why did I owe more than I expected for glasses?
You may have selected frames above the allowance or lens enhancements with additional copays. Ask the optical office to break down the charge line by line.
What extra savings does the plan include?
The plan includes a $150 allowance on featured frame brands, 20% savings on additional glasses and sunglasses from any VSP provider within 12 months of your last WellVision Exam, and no more than a $39 copay on routine retinal screening as an enhancement to the exam.
Can I use my HSA or FSA for vision expenses?
Yes. HSA or FSA dollars can be used for eligible vision expenses like the exam copay, eyeglasses, and contact lenses.
Who should I contact if a vision claim or charge does not make sense?
Start with the eye doctor’s office and VSP. If you are still not sure what happened, contact the Benefits team.

Need help?

If you are not sure where to start, begin with the Benefits team and we can help point you in the right direction.