Vision Plans
Effective 1/1/2010, vision services for benefit eligible City of Mesa
employees, retirees and their families will be offered by Vision Service
Plan (VSP).
Coverage
Members enrolled in the Basic Plan will be covered for an exam once
a year, lenses and frames (and contact lenses) once every two years; Vision
Plus Plan members will receive all services once every year.
Covered members who choose a VSP member doctor will receive a
comprehensive vision examination (including dilation) for a $10 copay.
Lenses and Frames may also be purchased at a $10 copay as well with
a $130 frame allowance. Any amounts over the $130 frame allowance will be
at a 20% discount. Single, Bifocal and Trifocal lenses are covered in full;
Executive trifocals, Progressives and Oversized lenses are offered at a
discounted rate.
A $200 Contact Lens Allowance will also be available in lieu of Lenses
and Frames.
For further information regarding your VSP benefits, please
visit their website at
www.vsp.com
.
The premiums for VSP for the 2013 plan year are as follows:
| Coverage |
Total Premium |
City Contribution |
Employee Contribution |
Per Paycheck |
| Single |
$5.06 |
$4.35 |
$0.53 |
$0.27 |
| Family |
$13.98 |
$7.08 |
$6.90 |
$3.45 |
| Coverage |
Total Premium |
City Contribution |
Employee Contribution |
Per Paycheck |
| Single |
$8.65 |
$4.53 |
$4.12 |
$2.06 |
| Family |
$23.84 |
$7.08 |
$16.76 |
$8.38 |
Out-of-Network Providers
Please complete the out-of-network claim
form, attach your
itemized receipts and mail to:
VSP
Attn: Out-of-Network Claims
PO Box 997105
Sacramento, CA 95899-7105
Important Notice
In order to process your claim the following
information must be provided by the non-VSP provider on the
itemized receipt. Your claim cannot be processed if this
information is missing.
- The name of the provider
- The name of the patient
- The date of service
- A complete description of each service provided (exam,
lens, frames or contacts)
- The amount paid for each service
By enclosing the request for reimbursement form along with
your itemized receipt your claim payment is expedited as it
ensures we have all of the necessary information.
Employee Benefits
20 E
Main Street, Ste 600
Mesa, AZ 85201
Open Mon -Thurs 7am-6pm
(480) 644-2299 - Phone
(480) 644-4548 - Fax
Option 2:
Medical/Dental Verify
Other Questions
Password
Resets
Option 3: Claim Status
Option 4:
Retiree Questions
Option 5:
Flex Spending
E-mail (password resets cannot be done via email)
Forms
Federally Mandated Notices