VSP Proprietary Confidential Member Out-of-Pocket Basic Plan, Progressive (no line bifocal) Lenses...
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Transcript of VSP Proprietary Confidential Member Out-of-Pocket Basic Plan, Progressive (no line bifocal) Lenses...
![Page 1: VSP Proprietary Confidential Member Out-of-Pocket Basic Plan, Progressive (no line bifocal) Lenses Signature Plan A Services Retail CostMember Cost with.](https://reader036.fdocuments.net/reader036/viewer/2022062401/5a4d1b8a7f8b9ab0599be7e4/html5/thumbnails/1.jpg)
VSP Proprietary & Confidential
Member Out-of-PocketBasic Plan, Progressive (no line bifocal) Lenses
Signature Plan A Services Retail Cost Member Cost with VSP
Signature Plan
Exam (copay applied) $ 173.80 $ 10.00
Frame - Jones of New York J107 $ 165.00 $ 28.00
Bifocal Lens (material copay applied) $ 127.00 $ 10.00
Hoyalux Summit Progressive Lens $ 146.00 $ 93.00
Super HiVision A/R Coating $ 115.00 $ 61.00
Annualized Premium ($6.72 / month) N/A $ 80.64
Total Out-of-Pocket Cost $ 726.80 $ 282.64
VSP saves $444.16 or 61%
![Page 2: VSP Proprietary Confidential Member Out-of-Pocket Basic Plan, Progressive (no line bifocal) Lenses Signature Plan A Services Retail CostMember Cost with.](https://reader036.fdocuments.net/reader036/viewer/2022062401/5a4d1b8a7f8b9ab0599be7e4/html5/thumbnails/2.jpg)
VSP Proprietary & Confidential
Member Out-of-PocketBasic Plan, Single Vision Lenses
Signature Plan A Services Retail Cost Member Cost with VSP
Signature Plan
Exam (copay applied) $ 173.80 $ 10.00
Frame – Sigrid Olsen SO105 $ 126.00 $ 0.00
Single Vision Lens (material copay applied) $ 75.00 $ 10.00
Super HiVision A/R Coating $ 115.00 $ 61.00
Polycarbonate (under 18) $ 50.00 $ 0.00
Annualized Premium ($6.72 / month) N/A $ 80.64
Total Out-of-Pocket Cost $ 539.80 $ 161.64
VSP saves $378.16 or 70%
![Page 3: VSP Proprietary Confidential Member Out-of-Pocket Basic Plan, Progressive (no line bifocal) Lenses Signature Plan A Services Retail CostMember Cost with.](https://reader036.fdocuments.net/reader036/viewer/2022062401/5a4d1b8a7f8b9ab0599be7e4/html5/thumbnails/3.jpg)
VSP Proprietary & Confidential
Member Out-of-PocketBuy-Up Plan, Progressive (no line bifocal) Lenses
Signature Plan C Services Retail Cost Member Cost with VSP
Signature Plan
Exam (copay applied) $ 173.80 $ 10.00
Frame - Jones of New York J107 $ 165.00 $ 28.00
Bifocal Lens (material copay applied) $ 127.00 $ 10.00
Hoyalux Summit Progressive Lens $ 146.00 $ 93.00
Super HiVision A/R Coating $ 115.00 $ 61.00
Annualized Premium ($9.98 / month) N/A $ 119.76
Total Out-of-Pocket Cost $ 726.80 $ 321.76
VSP saves $405.04 or 56%
![Page 4: VSP Proprietary Confidential Member Out-of-Pocket Basic Plan, Progressive (no line bifocal) Lenses Signature Plan A Services Retail CostMember Cost with.](https://reader036.fdocuments.net/reader036/viewer/2022062401/5a4d1b8a7f8b9ab0599be7e4/html5/thumbnails/4.jpg)
VSP Proprietary & Confidential
Member Out-of-PocketBuy Up Plan, Single Vision Lenses
Signature Plan C Services Retail Cost Member Cost with VSP
Signature Plan
Exam (copay applied) $ 173.80 $ 10.00
Frame – Sigrid Olsen SO105 $ 126.00 $ 0.00
Single Vision Lens (material copay applied) $ 75.00 $ 10.00
Super HiVision A/R Coating $ 115.00 $ 61.00
Polycarbonate (under 18) $ 50.00 $ 0.00
Annualized Premium ($9.98 / month) N/A $ 119.76
Total Out-of-Pocket Cost $ 539.80 $200.76
VSP saves $339.04 or 63%