Retiree Vision Care Plan

Princeton University offers a “retiree pay all” vision plan to eligible retirees. The vision plan is administered by Vision Service Plan (VSP). You have the choice of selecting the vision plan or waiving this benefit. Once enrolled, you may not terminate your vision coverage midyear.

VSP's Signature Plan covers:

diagnosis
treatment and monitoring of nonsurgical medical eye conditions
exams and specialized tests to identify medical conditions and vision loss
occular photography to determine the progress of abrasions, growths or glaucoma
follow – up care, including any necessary referrals and consultations with the member's primary care physician
all tints, polycarbonate lenses and scratch coatings

The plan offers savings on laser vision correction surgery.

The chart below is intended to provide an overview of plan benefits only.

Benefit	Frequency	Copayment	Coverage from a VSP Preferred Provider	Coverage from a VSP Affiliate Provider (Costco or Eye Care Centers of America)	Out-of-Network Reimbursement
Comprehensive Vision Exam	Once every calendar year	$10	Covered in full	Covered in full	Up to $43 allowance
Lenses¹	Once every calendar year	$20 (applied to lenses and frame)	Single vision, lined bifocal, lined trifocal, or lenticular prescription lenses are covered in full	Single vision, lined bifocal, lined trifocal, or lenticular prescription lenses are covered in full	Single vision up to $40 allowance Lined bifocal up to $60 allowance Lined trifocal up to $73 allowance
Frame²	Once every calendar year		Covered up to $155 retail allowance	Covered up to $85 retail allowance at Costco	Up to $47 allowance
Contact Lenses³ (materials, evaluation fee, and fitting costs)	Within 12 months of your last eye exam		Covered up to $140 allowance	Covered up to $140 allowance	Covered up to $140 allowance

The plan rates are located at the bottom of this page.

You cannot be reimbursed for glasses and contacts in the same calendar year.

¹ Lens options which can enhance the appearance, durability and function of your glasses are available to you at VSP’s member preferred pricing. Ask your doctor for details.

² If you choose a frame valued at more than your allowance, you will save 20% on your out-of-pocket costs for frames if you use a VSP preferred provider. If you use a VSP affiliate provider offers and discounts may vary. The Costco frame allowance of $85 is equivalent to the frame allowance at preferred providers.

³ Your allowance applies to the cost of your contact lens exam and your contact lenses. You will receive a 15% savings off the cost of your contact lens exam from a VSP preferred provider. Your contact lens exam is performed in addition to your routine eye exam to check for eye health risks associated with improper wearing or fitting of contacts. You may receive a 20% savings when you purchase non-covered pairs of prescription glasses, including prescription sunglasses from the same VSP preferred provider within 12 months of your last eye exam. If you use a VSP affiliate provider offers and discounts vary.

There is no benefit for professional services or materials connected with:

orthoptics or vision training and any associated supplemental testing
plano lenses (nonprescription)
two pair of glasses in lieu of bifocals
lenses and frames furnished under this program which are lost or broken will not be replaced except at the normal intervals when services are otherwise available
medical or surgical treatment of the eyes
any eye examination, or any corrective eye wear, required by an employer as a condition of employment
protective eyewear

How to Use Your VSP Vision Benefits

Locate a VSP Provider by either utilizing the VSP website and select the "Signature" network or by calling (800) 877-7195.

ID Card

There is no ID card issued for this benefit. If you are visiting a VSP participating provider, please provide your Social Security number to the participating provider who will contact VSP for plan provisions. If you prefer to have an ID card, you do have the option to print an ID card at www.vsp.com, under the "my benefits" section. The ID card will provide a summary of your benefits and includes information to help you manage your vision benefits.

How to Get Reimbursed for a Provider Not in the VSP network

Mail an itemized receipt to VSP, PO Box 997105, Sacramento, CA 95899-7105

2012 Plan Rates

Plan	Retiree Only	Retiree & Child	Retiree & Spouse	Retiree & Family
Vision Services Plan	$10.52	$19.28⁴	$19.28	$24.71

⁴ If you are enrolling more than one child, you must elect Retiree and Family

While the University intends to continue each of the benefit plans, the University reserves the right to terminate or amend any plan, at any time, and for any reason.