Vision Coverage Is Offered on All Plans

Coverage includes:

  • Yearly eye exam (including glaucoma screening) to diagnose and treat conditions of the eye.
  • Prescription eyeglass frames and lenses
  • Following cataract surgery, there is a supplement for one pair eyeglasses or one set of contact lenses included, however, you must pay 20% of the market cost.

Certain eye and vision services are not covered:

  • Radial keratotomy
  • LASIK surgery
  • Vision therapy
  • Low Vision Aid

Vision Providers

We contract with Vision Services Plan, or VSP, to provide you with vision services. The VSP Choice Network provides you with a list of contracted providers. You may go to any of our network providers listed in the VSP Choice Network Directory below for $0 copay eye exams. While you are a member of our plan, you must use network providers to get your covered services except in limited cases such as emergencies or urgently needed out-of-area care. With the exception of emergencies or urgent care, it may cost more to get care from out-of-network providers.

➔ Vision Network Directory (English and Spanish)

Vision Benefits by Plan

MA Plan 006
Specialty eye exam to diagnose conditions and diseases of the eye: $40 copay. If provider is in-network, then physician order is required. If provider is out-of-network, then plan approved referral is required.

Routine Eye exam with a VSP provider: $0 copay, limit one exam per year. If an out-of-network provider is used, a supplement of $47 can be applied toward total cost.

Eye wear: Lenses for eyeglasses have a $0 copay for one pair of glasses every 2 years. Members must use VSP network. Frames or contact lenses have a $100 benefits toward total cost. The remaining cost you pay out-of-pocket.

Out-of-Network Lenses – amount allowed toward cost:

  • Single Vision: $30
  • Lined bifocal or Progressive: $50
  • Lined trifocal: $75
  • Lenticular: $75

Out-of-Network Frames or Contact Lenses – amount allowed toward cost:

  • Frame: $45
  • Contact lenses: $85
MA Pharmacy Plan 008
Specialty eye exam to diagnose conditions and diseases of the eye: $40 copay. If provider is in-network, then physician order is required. If provider is out-of-network, then plan approved referral is required.

Routine Eye exam with a VSP provider: $0 copay, limit one exam per year. If an out-of-network provider is used, a supplement of $47 can be applied toward total cost.

Eye wear: Lenses for eyeglasses have a $0 copay for one pair of glasses every 2 years. Members must use VSP network. Frames or contact lenses have a $100 benefit toward total cost. The remaining cost you pay out-of-pocket.

Out-of-Network Lenses – amount allowed toward cost:

  • Single Vision: $30
  • Lined bifocal or Progressive: $50
  • Lined trifocal: $60
  • Lenticular: $75

Out-of-Network Frames or Contact Lenses – amount allowed toward cost:

  • Frame: $45
  • Contact lenses: $85
MA Pharmacy Plan 009
Specialty eye exam to diagnose conditions and diseases of the eye: $40 copay. If provider is in-network, then physician order is required. If provider is out-of-network, then plan approved referral is required.

Routine Eye exam with a VSP provider: $0 copay, limit one exam per year. If an out-of-network provider is used, a supplement of $47 can be applied toward total cost.

Eye wear: Lenses for eyeglasses have a $0 copay for one pair of glasses every 2 years. Members must use VSP network. Frames or contact lenses have a $100 benefit toward total cost. The remaining cost you pay out-of-pocket.

Out-of-Network Lenses – amount allowed toward cost:

  • Single Vision: $30
  • Lined bifocal or Progressive: $50
  • Lined trifocal: $60
  • Lenticular: $75

Out-of-Network Frames or Contact Lenses – amount allowed toward cost:

  • Frame: $45
  • Contact lenses: $85
MA Extra Plan 010
Specialty eye exam to diagnose conditions and diseases of the eye: 20% coinsurance. If provider is in-network, then physician order is required. If provider is out-of-network, then plan approved referral is required.

Routine Eye exam with a VSP provider: $0 copay, limit one exam per year. If an out-of-network provider is used, a supplement of $47 can be applied toward total cost.

Eye wear: Lenses for eyeglasses have a $0 copay for one pair of glasses every 2 years. Members must use VSP network. Frames or contact lenses have a $100 benefit toward total cost. The remaining cost you pay out-of-pocket.

Out-of-Network Lenses – amount allowed toward cost:

  • Single Vision: $30
  • Lined bifocal or Progressive: $50
  • Lined trifocal: $60
  • Lenticular: $75

Out-of-Network Frames or Contact Lenses – amount allowed toward cost:

  • Frame: $45
  • Contact lenses: $85
MA Special Needs Plan 014
Specialty eye exam to diagnose conditions and diseases of the eye: 0% of the cost. If provider is in-network, then physician order is required. If provider is out-of-network, then plan approved referral is required.

Routine Eye exam with a VSP provider: 0% of the cost, limit one exam per year. If an out-of-network provider is used, a supplement of $47 can be applied toward total cost.

Eye wear: Lenses for eyeglasses have a $0 copay for one pair of glasses every 2 years. Members must use VSP network. Frames or contact lenses have a $130 benefit toward total cost. The remaining cost you pay out-of-pocket.

Out-of-Network Lenses – amount allowed toward cost:

  • Single Vision: $30
  • Lined bifocal or Progressive: $50
  • Lined trifocal: $60
  • Lenticular: $75

Out-of-Network Frames or Contact Lenses – amount allowed toward cost:

  • Frame: $45
  • Contact lenses: $85
MA Value Plan 016
Specialty eye exam to diagnose conditions and diseases of the eye: 20% coinsurance. If provider is in-network, then physician order is required. If provider is out-of-network, then plan approved referral is required.

Routine Eye exam with a VSP provider: $0 copay, limit one exam per year. If an out-of-network provider is used, a supplement of $47 can be applied toward total cost.

Eye wear: Lenses for eyeglasses have a $0 copay for one pair of glasses every 2 years. Members must use VSP network. Frames or contact lenses have a $100 benefit toward total cost. The remaining cost you pay out-of-pocket.

Out-of-Network Lenses – amount allowed toward cost:

  • Single Vision: $30
  • Lined bifocal or Progressive: $50
  • Lined trifocal: $60
  • Lenticular: $75

Out-of-Network Frames or Contact Lenses – amount allowed toward cost:

  • Frame: $45
  • Contact lenses: $85

DID YOU KNOW...?

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One of our community health center partners, HealthPoint has many locations across King County. Their approach to health care is to bring together all the services someone needs to be healthy, in one place. We support their model of whole person care and together, our goal is healthier people and a healthier community.

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