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    US Apple Vision Plan Overview JAN152021 en

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    CT Nguon
    The 2021 Apple Vision Plan is administered by Vision Service Plan (VSP) and provides vision coverage for employees and their dependents. Using an in-network VSP provider saves money through negotiated rates. The plan covers annual eye exams, lenses, frames, and contact lenses. Co-pays and allowances vary for in-network versus out-of-network coverage. Employee premium costs are deducted on a pre-tax basis and vary based on coverage level and employment status. The Apple Benefits Book provides full plan details.

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    US Apple Vision Plan Overview JAN152021 en

    Uploaded by

    CT Nguon
    1K views1 page
    The 2021 Apple Vision Plan is administered by Vision Service Plan (VSP) and provides vision coverage for employees and their dependents. Using an in-network VSP provider saves money through negotiated rates. The plan covers annual eye exams, lenses, frames, and contact lenses. Co-pays and allowances vary for in-network versus out-of-network coverage. Employee premium costs are deducted on a pre-tax basis and vary based on coverage level and employment status. The Apple Benefits Book provides full plan details.

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    The 2021 Apple Vision Plan is administered by Vision Service Plan (VSP) and provides vision coverage for employees and their dependents. Using an in-network VSP provider saves money through negotiated rates. The plan covers annual eye exams, lenses, frames, and contact lenses. Co-pays and allowances vary for in-network versus out-of-network coverage. Employee premium costs are deducted on a pre-tax basis and vary based on coverage level and employment status. The Apple Benefits Book provides full plan details.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    1K views1 page

    US Apple Vision Plan Overview JAN152021 en

    Uploaded by

    CT Nguon
    The 2021 Apple Vision Plan is administered by Vision Service Plan (VSP) and provides vision coverage for employees and their dependents. Using an in-network VSP provider saves money through negotiated rates. The plan covers annual eye exams, lenses, frames, and contact lenses. Co-pays and allowances vary for in-network versus out-of-network coverage. Employee premium costs are deducted on a pre-tax basis and vary based on coverage level and employment status. The Apple Benefits Book provides full plan details.

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    of 1

    2021 Apple Vision Plan Overview

    Plan Name Vision Service Plan (VSP)


    Group #: 00865701
    Member Services: 877-666-2185

    Overview The summary below highlights some of the features of the AppleVision Plan. For comprehensive
    details about the plan, see the Apple Benefits Book.

    When you use a VSP participating provider, the Apple Vision Plan provides a higher level of
    coverage, which will save you and Apple money, since payments are based on negotiated rates.

    How the Apple Vision Plan Works

    Network Type In-Network Out-of-Network

    Annual Eye Exam 100%; once every 12 months $50 maximum benefit; once every 12 months
    Exam includes retinal screening

    Glasses-Lenses UV protection covered in full $50-$125 benefit based on lens type, after a
    $10 copay for anti-reflective coating $10 copay
    Medically necessary Pink 1 and 2 tinted lenses: UV protection and anti-reflective coating:
    Covered in full Not covered
    One set every 12 months Medically necessary Pink 1 and 2 tinted lenses:
    Not covered
    One set every 12 months

    Glasses-Frames $10 copay; up to $150 retail frame allowance $70 maximum benefit, after a $10 copay
    (20% discount for amounts over allowance) One set every 12 months
    One set every 12 months

    Contacts, Elective $150 maximum benefit $110 maximum benefit

    Contacts, Visually Necessary Covered in full, after a $10 copay $210 maximum benefit, after a $10 copay

    Supplement Care Aids Requires precertification for the Low Vision benefit.
    75% of VSP approved amount after 25% copay, up to $1000 every two years, restrictions apply

    Laser Vision Surgery Not a covered benefit; however, VSP offers discounts averaging 15% off of provider’s usual and
    customary price for PRK, Lasik and Custom Lasik.

    Before-Tax Cost

    Employee Per Pay Period: Full-Time: $1.22 / Part-Time: $1.30


    Per Month: Full-Time: $2.64 / Part-Time: $2.82
    Per Year: Full-Time: $31.68 / Part-Time: $33.84

    Employee + Spouse or Domestic Partner Per Pay Period: Full-Time: $2.69 / Part-Time: $5.51
    Per Month: Full-Time: $5.83 / Part-Time: $11.94
    Per Year: Full-Time: $69.96 / Part-Time: $143.28

    Employee + Child(ren) Per Pay Period: Full-Time: $2.22 / Part-Time: $4.36


    Per Month: Full-Time: $4.81 / Part-Time: $9.45
    Per Year: Full-Time: $57.72 / Part-Time: $113.40

    Employee + Family Per Pay Period: Full-Time: $3.72 / Part-Time: $8.58


    Per Month: Full-Time: $8.06 / Part-Time: $18.59
    Per Year: Full-Time: $96.72 / Part-Time: $223.08

    The Apple Vision Plan Chart highlights commonly used services and generally indicates how you and the vision plan will cover vision expenses you
    and/or your enrolled dependents incur. Some services are subject to frequency and coverage limits. This chart does not reflect all covered services,
    plan exclusions, limitations or restrictions. It is not a contract or guarantee of coverage. See the Apple Benefits Book for more information.

    2021 Apple Vision Plan Overview 1

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