Watch our video

How vision insurance can help

you see clearly as you get older.

Vision
insurance
Vision insurance helps protect the 20/20 coverage
health of your eyes by providing coverage David notices that his vision is
deteriorating. He goes in for an eye
for benefits that often aren’t covered exam, and is diagnosed with myopia,
by regular medical insurance. which means he needs glasses.

Protecting your eyesight means allowing for routine visits

to the optometrist for eye exams, as well as coverage for Average cost of vision exam: $171
glasses and contacts. Make sure your eyes remain in great
shape at any age – no matter how much time you spend Average cost of frames and
staring at digital screens. lenses: $350
Total cost: $521
Who is it for? With a Vision policy from Guardian,
Even if you have perfect eyesight, it’s important to have regular eye exams David pays just $10 for his eye exam.
to make sure you’re still seeing clearly. Most of us may eventually need After $25 in copay, his lenses are fully
vision correction, which is why we offer vision insurance to cover some of covered, and he pays $96 for his
the costs. frames.
David’s total out-of-pocket expense
What does it cover? is $131, saving him $390.
Vision insurance covers benefits not typically included in medical insurance
plans. It covers things like routine eye exams, allowances towards the
purchase of eyeglasses and contact lenses, as well as discounts on
corrective Lasik surgery.

Why should I consider it?

Regular eye exams can detect more than failing eyesight, they can also pick
up diseases like glaucoma and diabetes. Vision problems are one of the
most prevalent disabilities in the United States, making vision insurance
especially useful for anyone who regularly needs to purchase eyeglasses or
contacts, or anyone who simply wants to help protect their eyesight and This example is for illustrative
general health. purposes only. Your plan’s coverage
may vary. See your plan’s information
on the following pages for specific
amounts and details.
You will receive these benefits if you meet the conditions listed in the policy.

GUARDIAN® is a registered trademark of The Guardian Life Insurance Company of America

PLUME DESIGN, INC. Kit created 10/21/2021
ALL ELIGIBLE EMPLOYEES Group number:00547339 9
2020-104313 (07/22)
Your vision coverage
Option 1: Significant out-of-pocket savings available with your Full Feature plan by visiting one of VSP’s network locations,
including one of the largest private practice provider networks, Visionworks and contracted Pearle Vision locations.

Your Vision Plan Full Feature

Your Network is VSP Choice Network
Copay
Exams Copay $ 10
Materials Copay (waived for elective contact lenses) $ 25
Sample of Covered Services You pay (after copay if applicable):
In-network Out-of-network
Eye Exams $0 Amount over $39
Single Vision Lenses $0 Amount over $23
Lined Bifocal Lenses $0 Amount over $37
Lined Trifocal Lenses $0 Amount over $49
Lenticular Lenses $0 Amount over $64
Frames 80% of amount over $150¹ Amount over $46
Costco, Walmart and Sam's Club Frame Allowance Amount over $80
Contact Lenses (Elective) Amount over $150 Amount over $100
Contact Lenses (Medically Necessary) $0 Amount over $210
Contact Lenses (Evaluation and fitting) 15% off UCR No discounts
Cosmetic Extras Avg. 20-25% off retail price No discounts
Glasses (Additional pair of frames and lenses) 20% off retail price** No discounts
Laser Correction Surgery Discount Up to 15% off the usual charge or 5% No discounts
off promotional price
Service Frequencies
Exams Every calendar year
Lenses (for glasses or contact lenses)‡‡ Every calendar year
Frames Every calendar year
Network discounts (glasses and contact lens professional service) Limitless within 12 months of exam.
Dependent Age Limits 26
To Find a Provider: Register at VSP.com to find a participating provider.

VSP
• Additional Features Benefits: Second Pair Rider
• ‡‡Benefit includes coverage for glasses or contact lenses, not both.
• ** For the discount to apply your purchase must be made within 12 months of the eye exam.
• Charges for an initial purchase can be used toward the material allowance. Any unused balance remaining after the initial purchase cannot be banked for future use.
The only exception would be if a member purchases contact lenses from an out of network provider, members can use the balance towards additional contact
lenses within the same benefit period.

GUARDIAN® is a registered trademark of The Guardian Life Insurance Company of America

PLUME DESIGN, INC. Kit created 10/21/2021
10
ALL ELIGIBLE EMPLOYEES Group number: 00547339
Your vision coverage
1
• Extra $20 on select brands
• Members can use their in network benefits on line at Eyeconic.com.

EXCLUSIONS AND LIMITATIONS

Important Information: This policy provides vision care limited benefits health The services, exclusions and limitations listed above do not constitute a
insurance only. It does not provide basic hospital, basic medical or major contract and are a summary only. The Guardian plan documents are the final
medical insurance as defined by the New York State Insurance Department. arbiter of coverage. Contract #GP-1-VSN-96-VIS et al.
Coverage is limited to those charges that are necessary for a routine vision
examination. Co-pays apply. The plan does not pay for: orthoptics or vision Laser Correction Surgery:
training and any associated supplemental testing; medical or surgical treatment
of the eye; and eye examination or corrective eyewear required by an Discounts on average of 10-20% off usual and customary charge or 5% off
employer as a condition of employment; replacement of lenses and frames promotional price for vision laser Surgery. Members out-of-pocket costs are
that are furnished under this plan, which are lost or broken (except at normal limited to $1,800 per eye for LASIK or $1,500 per eye for PRK or $2300 per
intervals when services are otherwise available or a warranty exists). The plan eye for Custom LASIK, Custom PRK, or Bladeless LASIK.
limits benefits for blended lenses, oversized lenses, photochromic lenses,
tinted lenses, progressive multifocal lenses, coated or laminated lenses, a Laser surgery is not an insured benefit. The surgery is available at a discounted
frame that exceeds plan allowance, cosmetic lenses; U-V protected lenses and fee. The covered person must pay the entire discounted fee. In addition, the
optional cosmetic processes. laser surgery discount may not be available in all states.

Guardian’s Vision Insurance is underwritten and issued by The Guardian Life Insurance Company of America, New York, NY. Products are not available in all
states. Policy limitations and exclusions apply. Optional riders and/or features may incur additional costs. This policy provides vision care limited benefits health
insurance only. It does NOT provide basic hospital, basic medical or major medical insurance as defined by the New York State Department of Financial
Services. Plan documents are the final arbiter of coverage.
Policy Form # GP-1-GVSN-17

GUARDIAN® is a registered trademark of The Guardian Life Insurance Company of America

PLUME DESIGN, INC. Kit created 10/21/2021
11
ALL ELIGIBLE EMPLOYEES Group number: 00547339