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Gap Vision Plan
Individual - $14 per month
Individual+1 - $27 per month
Family - $43 per month
Yearly eye exams are an easy and important way to protect your eyes and overall health. A routine eye exam can help detect signs of serious health conditions, like diabetes, a brain tumor and high cholesterol.^ The Gap Vision Plan is a great fit for families, people who want to get regular vision check-ups, or those that just want that extra layer of protection for some of their out-of-pocket costs due to vision exams, frames, lenses and contacts.
^ What do your eyes say aobut your overall health. VSP. https://www.vsp.com/comprehensive-eye-exam.html
GROUP VISION INSURANCE
Coverage is available to paid Members of the United Business Association after the effective date listed in your welcome letter following the receipt of the Membership application and the payment of the first month's dues to the United Business Association.
Insurance benefits are underwritten by Renaissance Life & Health Insurance Company of America, Indianapolis, IN and in New York by Renaissance Life & Health Insurance Company of New York, New York, NY. Both companies (“Renaissance”) can be reached at P.O. Box 1596, Indianapolis, IN 46206. There is no ownership affiliation between Renaissance and Gap Dental & Vision. For complete coverage details, please refer to the certificate of insurance.
|Well Vision Exam
||COPAY & FREQUENCY
Every 12 months
See Frames & Lenses Below
Every 12 Months
FRAMES & LENSES*
For a wide selection of frames.
20% savings on the amount
over your allowance.
Single vision, lined bifocal,
lined trifocal & lentricular
lenses. Polycarbonate lenses
for dependent children only.
*Included in Prescription Glasses.
The information is a limited description of the plan highlights. For more details, limitations, exclusions & defintions, please refer to the Certificate.
ADDITIONAL VISION BENEFITS
Every 12 months
(Average Savings of 20%-25% for other lens enhancements)
Contacts (instead of glasses)
- COPAY UP TO $60
applies to contact evaluation and fitting - every 12 months
- $130 Allowance for contacts; copay does not apply.
- Contact lense exam (evaluation and fitting) - Medically Necessary covered in full after $25 copay.
When Contact Lenses are obtained, the Covered Person shall not be eligible for lenses and frames again in the next 12 months.
Approximately 14 million Americans aged 12 years and older have self-reported visual impairment defined as distance visual acuity of 20/50 or worse. Among them, more than 11 million Americans could have improved their vision to 20/40 or better with refractive correction.1
1Stats taken from: https://www.cdc.gov/visionhealth/data/national.htm
THIS IS NOT COMPREHENSIVE MAJOR MEDICAL INSURANCE. THIS IS A VISION ONLY POLICY.
The information is a limited description of the plan highlights. For more details, limitations, exclusions and definitions, please refer to the Certificate. Insurance benefits are underwritten by Renaissance Life & Health Insurance Company of America, Indianapolis, IN and in New York by Renaissance Life & Health Insurance Company of New York, New York, NY. Both companies (“Renaissance”) can be reached at P.O. Box 1596, Indianapolis, IN 46206. There is no ownership affiliation between Renaissance and Gap Dental & Vision. For complete coverage details, please refer to the certificate of insurance.
SINGLE VISION LENSES
Up to $30
LINED BIFOCAL LENSES
Up to $50
LINED TRIFOCAL LENSES
Up to $65
Up to $50
Up to $100
Up to $105
*Visit www.vsp.com for details if you plan to see a provider other than a VSP Doctor.
1 Contact Lenses - (necessary - $210)
GLASSES / SUNGLASSES1
LASER VISION CORRECTION3
1 20% savings on additional glasses / sunglasses, including lens enhancements, from any VSP doctor within 12 months of your WellVision Exam.
2 5% savings on a contact lens exam (fitting and evaluation).
3 Average 15% off the regular price or 5% off the promotional price, discounts only available from contracted facilities.
Gap Vision Plan State Availability
AL, AR, AZ, CA, GA, KS, MI, MS, OK, & TX
HOW TO FILE A VISION CLAIM
Note: There are no claim forms to complete when you visit a VSP participating doctor.
United Business Association Claims Unit
Renaissance Life & Health Insurance Company of America
P.O Box 17250, Indianapolis, IN 46217
Eligibility & Benefit Info: 888.358.9484
To receive Covered Services from an In-Network Provider, Covered Person should select an In-Network Provider, schedule an appointment and inform the Provider's office that you are a Covered Person under this vision plan. The In-Network Provider will then obtain a Benefit Authorization prior to the time services are rendered or materials ordered. Services must be obtained before the expiration date of the Benefit Authorization. If a Covered Person receives Covered Services from an In-Network Provider WITHOUT a Benefit Authorization, any services or materials received from the In-Network Provider will be treated as if they were obtained from an Out-of-Network Provider. If a Covered Person is eligible for and obtains Benefits from an Out-of-Network Provider, Covered Person remains liable for the Out-of-Network Provider's full fee.Covered Persons or Out-of-Network Providers may submit requests for reimbursement. Claims will be paid to Covered Persons or directly to Out-of-Network Providers when claims include a valid Assignment of Benefits. Claims may be denied if recieved 180 calendar days from the date services are rendered and/or materials provided.
Benefit payment is subject to the plan provisions, limitations, exclusions and other provisions within the Certificate. For more informaiton and complete details of terms, conditions, limitations, and exclusions of coverage, please refer to the Certificate. Coverage may vary and may not be available in all states. Renaissance does not provide nor is affliated with the discount programs provided as part of membership in the United Business Association.
United Business Association
The United Business Association (UBA) is a nationwide membership of small business owners and employees. UBA leverages our purchasing power to secure benefits and discounts not otherwise available on an individual basis. With group insurance programs, shared business knowledge, business and lifestyle benefits and services and opportunities to network, We are Better Together. Your membership in the United Business Association allows you to access and enroll in any additional Gap Plan that provides an insured benefit. Various insurance companies have issued group limited benefit insurance policies to the United Business Association as the group master policyholder. Product features, additional plans and availability may vary by state. View UBA's Refund / Cancellation Policy.
*Plan Costs listed at the top of the page do not include the separate $10 UBA Membership dues. You must be a member of the United Business Association to access and enroll in this Gap Plan.