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<br /> VISION SERVICE PLAN <br /> PRINCIPAL BENEFITS AND COVERAGE <br /> SERVICES FROM VSP PANEL DOCTORS <br />1. VISION EX&~INATION <br /> A complete analysis of the eyes and related structures to determine <br /> the presence of vision problems or other abnormalities. <br /> Each covered person shall be entitled to a vision examination once <br /> each twelve (12) months. <br />II. MATERIALS <br /> Where the vision examination indicates that new lenses or frames or <br /> both are necessary for the proper visual health and welfare of a <br /> covered person, they will be supplied, together with such professional <br /> services as are necessary, which shall include, but not be limited to: <br /> 1) Prescribing and ordering proper lenses <br /> 2) Assisting in the selection of a frame <br /> 3) Verifying the accuracy of the finished lenses <br /> 4) Proper fitting and adjustment of the spectacles <br /> A. LENSES - The VSP Panel Doctor will order the proper lenses <br /> necessary for the patient's visual welfare. <br /> Each covered person is entitled to new lenses once each <br /> twelve (12) months if replacement is deemed necessary by <br /> the doctor. <br /> B. FRAMES - New frames will be provided once each twenty-four (24) <br /> months if replacëment is deemed necessary by the doctor. <br /> COPAYMENT PROVISIONS - ~TSP reserves the right to limit the cost <br /> of the frames provided by its Pan~l Doctors under the plan. The <br /> limit shall be publish~ci periodically by VSP to its Panel Doctors <br /> and will be set at a level to ~ov~r the majori~y of frames in <br /> common use. <br /> IF THE COVERED PERSON WISHES TO SELECT A MORE EXPENSIVE FRÞ~E <br /> THAN THAT ALLOWED UNDER THE PROGR&~, THE COST DIFFERENCE SHALL BE <br /> BY AGREEMENT BETWEEN THE COVERED PERSON fu~ THE DOCTOR. <br /> -2- <br /> 10/81B <br /> - <br />