Guardian VSP Vision Insurance Plan

Guardian VSP Provider Network

Guardian Notice of Privacy Practices

Group Plan Number: 00460832

Helpline (888) 600-1600, 8:00 AM to 8:30 PM, EST








UNDERSTAND YOUR PLAN


Visit any doctor with your Full Feature plan, but save by visiting any of the 34,000 locations in the nation’s largest vision network.

YOUR GUARDIAN PLAN OFFERS:
  • Family coverage for spouse and children to age 25 (26 if full-time student).
  • Reduced prices - An average 15% to 30% discount off an extensive list of “cosmetic extras”, including special lenses and scratch-resistant coatings.
  • No claims submission for in-network services and supplies.
       
  MONTHLY PREMIUMS  
  Employee $ 9.88  
  Employee and Spouse $16.62  
  Employee and Child(ren) $16.96  
  You, Spouse and Child(ren) $26.84  
       
  Copays    
  Exams Copay $20.00  
  Materials Copay (waived for elective
contact lenses)

$20.00  
       
  Service Frequencies    
  Exams Every calendar year  
  Lenses *(for glasses or contact lenses) Every calendar year  
  Frames Every two calendar years  
  Network discounts
(Cosmetic extras, glasses and
Contact lens professional service)

Limitless within 12 months of exam  
       
  Network VSP  
  PLAN DETAILS FULL FEATURE  
    In-Network Out-of-Network
  Eye Exams Covered in Full after Copay $ 50.00 Maximum after Copay
  Single Vision Lenses Covered in Full after Copay $ 48.00 Maximum after Copay
  Lined Bifocal Lenses Covered in Full after Copay $ 67.00 Maximum after Copay
  Lined Trifocal Lenses Covered in Full after Copay $ 86.00 Maximum after Copay
  Lenticular Lenses Covered in Full after Copay $126.00 Maximum after Copay
  Frames $130.00
Retail Allowance **
$ 48.00 Maximum after Copay
  Contact Lenses
* (Elective)
VSP Contact Lens
Care Program
(click here for information)
$130.00 Maximum
(CoPay does not apply
$120.00 Maximum
(Copay does not apply)
  Contact Lenses
* (Medically Necessary)
Covered in Full after Copay $210 Maximum after Copay
  Contact Lenses
(Evaluation and fitting)
15% off UCR No discounts
  Cosmetic Extras
(Special lenses, scratch-resistant coatings, etc.)
Avg. 20-30% 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% off the promotional price

No discounts
       
  This is only a partial list of vision services. Your certificate of benefits will show exactly what is covered and excluded.
  * Contact Lenses - Once a Calendar Year, in lieu of a complete set of glasses.
  ** For the discount to apply your purchase must be made within 12 months of the eye exam. In addition Full-feature plans offer 30% off additional glasses and sunglasses, including lens options, if purchased on the same day as the eye exam from the same VSP doctor who provided the exam.
       
  Questions?

Call the Guardian Helpline (888) 600-1600
Call weekdays, 8:00 AM to 8:30 PM, EST

www.guardianlife.com



Reginald Lillie Insurance Service
16611 Canterra Way
Houston, TX 77095
Phone: 281-213-9663
Fax: 281-256-9902
Email: rlillieins@sbcglobal.net


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