Your VSP Vision Benefits Summary Prioritize your health and your budget with a VSP plan through BALL STATE UNIVERSITY. Get coverage for essentials, or upgrade to enhance your coverage options. COPAY DESCRIPTION BENEFIT COPAY DESCRIPTION BENEFIT Premium Coverage with a VSP Provider Standard Coverage with a VSP Doctor $0 WELLVISION EXAM $15 WELLVISION EXAM Focuses on your eyes and overall wellness Focuses on your eyes and overall wellness Up to $39 Up to $39 Routine retinal screening Routine retinal screening Every calendar year Every calendar year ESSENTIAL MEDICAL EYE CARE ESSENTIAL MEDICAL EYE CARE Retinal imaging for members with diabetes covered-in-full Retinal imaging for members with diabetes covered-in-full $20 per exam $20 per exam Additional exams and services beyond routine care to treat immediate issues from pink eye to sudden changes in vision or to monitor ongoing conditions such as dry eye, diabetic eye disease, glaucoma, and more. Additional exams and services beyond routine care to treat immediate issues from pink eye to sudden changes in vision or to monitor ongoing conditions such as dry eye, diabetic eye disease, glaucoma, and more. Coordination with your medical coverage may apply. Ask your VSP network doctor for details. Coordination with your medical coverage may apply. Ask your VSP network doctor for details. Available as needed Available as needed PRESCRIPTION GLASSES $25 PRESCRIPTION GLASSES Included in Prescription Glasses FRAME⁺ $0 FRAME⁺ $170 Featured Frame Brands allowance $250 Featured Frame Brands allowance $150 frame allowance $250 Visionworks or Eyemart Express frame allowance on any frame 20% savings on the amount over your allowance $200 frame allowance $80 Walmart/Sam's Club/Costco frame allowance 20% savings on the amount over your allowance Every other calendar year $110 Walmart/Sam's Club/Costco frame allowance Included in Prescription Glasses LENSES Single vision, lined bifocal, and lined trifocal lenses Every calendar year $0 LENSES Impact-resistant lenses for dependent children Single vision, lined bifocal, and lined trifocal lenses Every calendar year Every calendar year $0 LENS ENHANCEMENTS $0 LENS ENHANCEMENTS Standard progressive lenses Standard progressive lenses $95 - $105 Premium progressive lenses $95 - $105 Premium progressive lenses $150 - $175 Custom progressive lenses $150 - $175 Custom progressive lenses Average savings of 30% on other lens enhancements $0 Impact-resistant lenses $0 UV protection Every calendar year Average savings of 30% on other lens enhancements Up to $60 CONTACTS (INSTEAD OF GLASSES) Every calendar year $150 allowance for contacts; copay does not apply Up to $60 CONTACTS (INSTEAD OF GLASSES) Contact lens exam (fitting and evaluation) $200 allowance for contacts; copay does not apply Every calendar year Contact lens exam (fitting and evaluation) $25 VSP LIGHTCARE TM+ $150 allowance for ready-made non-prescription sunglasses, or ready-made non-prescription blue light filtering glasses, instead of prescription glasses or contacts. Every calendar year VSP LIGHTCARE TM⁺ $0 $200 allowance for ready-made non-prescription sunglasses, or ready-made non-prescription blue light filtering glasses, instead of prescription glasses or contacts Every calendar year Every calendar year Glasses and Sunglasses ADDITIONAL SAVINGS Discover all current eyewear offers and savings at vsp.com/offers. 20% savings on unlimited additional pairs of prescription or non-prescription glasses/sunglasses, including lens enhancements, from a VSP provider within 12 months of your last WellVision Exam. Laser Vision Correction Average of 15% off the regular price; discounts available at contracted facilities. Exclusive Member Extras for VSP Members Contact lens rebates, lens satisfaction guarantees, and more offers at vsp.com/offers. Save up to 60% on digital hearing aids with TruHearing®. Visit vsp.com/offers/special-offers/hearing-aids for details. Enjoy everyday savings on health, wellness, and more with VSP Simple Values. GET MORE AT PREFERRED IN-NETWORK LOCATIONS With so many in-network choices, VSP makes it easy to get the most out of your benefits. You’ll have access to preferred private practice, retail, and online in-network choices. Log in to vsp.com to find an in-network provider. Provider Network: VSP Choice Effective Date: 01/01/2026