Vision – Young Life

Vision Plan*

Vision coverage is provided through Vision Service Plan (VSP). This is an employer-paid benefit for eligible employees and family members enrolled in the Young Life Benefits plan. The plan provides first-dollar coverage for in-network providers with a copay and coverage up to a specified maximum for out-of-network providers. Additionally, special member pricing is offered for various services, lenses, contacts, and frames when received from in-network providers.

Col 1	col2	col3
VSP
	In-Network	Out-of-Network
Exams	$25 copay ($10 additional for retinal screening)	Up to $40*
Single Vision Lenses	Covered in full*	Up to $40*
Bifocal Lenses	Covered in full*	Up to $60*
Frames	$200 allowance	Up to $70*
Contacts	$200 allowance	Up to $200
Medically Necessary Contacts	Covered in full*	Up to $210*
Summary of Frequencies Exam Lenses Frames Contacts (in lieu of glasses)	Available once every calendar year Available once every calendar year Available once every calendar year Available once every calendar year

The content of this chart is for informational purposes only. If there is any conflict between the information in this chart and the official plan document, the official plan document will govern.

*Note: Special Forms and handling are provided for international claims, and in-network benefits are applied.