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 Advantage Network provides you with a list of contracted providers. You may go to any of our network providers listed in the VSP Advantage 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...?

Support for the Chronically Homeless

Our health clinic partner, Yakima Neighborhood Health Services (YNHS), has opened a resource center to help the homeless population in Yakima. Read more about the new Rhonda D. Hauff Resource Center in our blog.

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