Vision Plan for members of Alternative Health Insurance Services
|
Plan Benefits
|
|
|
|
|
Low
|
|
High
|
Exam Every
|
12 Months
|
|
12 Months
|
Lenses Every
|
12 Months
|
|
12 Months
|
Frames Every
|
24 Months
|
|
12 Months
|
|
|
|
|
| Co-Payment |
|
|
|
Exam
|
$15
|
|
$10
|
Materials
|
$25
|
|
$25
|
|
|
|
|
Frame Allowances
|
|
|
|
|
|
|
|
Retail
|
$110
|
|
$130
|
|
|
|
|
Lens Allowances
|
|
|
|
Elective Contact
|
$120
|
|
$125
|
Tints & Photo Chromic
|
Discounts
|
|
Covered In Full
|
Polycarbonate
|
Discounts
|
|
Covered In Full
|
Progressive
|
Discounts
|
|
Discounts
|
|
|
|
|
Out of Network Schedule
|
(Up to)
|
|
|
Examination
|
$40
|
|
$40
|
Single Vision Lenses
|
$35
|
|
$35
|
Bifocal Lenses
|
$52
|
|
$52
|
Trifocal Lenses
|
$65
|
|
$65
|
Lenticular Lenses
|
$80
|
|
$80
|
Frame
|
$45
|
|
$45
|
Elective Contact Lenses
|
$100
|
|
$105
|
|
|
|
|
Monthly Costs
|
|
|
|
Member Only
|
$9.48
|
|
$13.98
|
Member & Spouse
|
$14.48
|
|
$21.48
|
Member & Child(ren)
|
$14.98
|
|
$21.98
|
Member & Family
|
$22.98
|
|
$34.48
|
|
|
|
|
Monthly Fees
|
|
|
|
Association Dues
|
$5.00
|
|
$5.00
|
(Fees reduced when paying annually or semi-annually)
|
VSP was established in 1955 and is dedicated to offering affordable, high-quality eyecare plans that put people first, support visual wellness and improve one's quality of life. As the nation's largest provider of eyecare coverage, thousands of companies rely on VSP to provide a range of vision programs.
With over 41 million members nationwide, one in eight people in the united states rely on VSP for eyecare health coverage. VSP has contracts with over 22,000 clients, including 217 fortune 500 companies.
VSP has a network of over 22,000 doctors. Their doctor network is so comprehensive, that more than ninety percent of members have access to a VSP doctor within ten miles of work and home.
No ID cards - No claim forms.
Easy as 1, 2, 3.
- Find a VSP network doctor at www.vsp.com or call 1-800-877-7195
- Make an appointment and tell the doctor you are a VSP member.
- Your doctor and VSP will handle the rest.
How to Enroll
- Complete and sign the Alternative Health Insurance Services Application below
- Complete the Vision Application
- Mail completed forms to Alternative Health Insurance Services with your payment
Payment Options
- Annual Payment: Multiply the monthly payment for the plan selected by 12 and add the reduced annual association fee of $40.
- Semi-Annual Payment: Multiply the monthly payment for the plan selected by 6 and add the reduced semi-annual association fee of $25.
- Quarterly Payment: Multiply the monthly payment for the plan selected by 3 and add the quarterly association fee of $15.
Membership Application & Agreement
I hereby apply to join Alternative Health Insurance Services and enclose the appropriate fees as shown above for association dues and vision benefits.
|
Payment Mode Selected:
|
|
Annual Payment
|
|
|
Semi Annual Payment
|
|
|
Quarterly Payment
|
|
|
|
Plan Selected:
|
|
High Benefit Plan
|
|
|
Low Benefit Plan
|
|
I understand that there is a one-year commitment to remain on the vision plan and agree to remain on the plan for no less than one year.
Should Alternative Health Insurance Services (AHIS) be required to enforce the minimum participation period stated above, I waive my rights to choose a legal venue or jurisdiction other than that venue selected by AHIS.
|
Name: ___________________________________________________
Street Address: ___________________________________________
City: ______________________ State: _____ Zip Code: _________
Phone: (___) _______________ Email: ________________________
I hereby agree to and accept the terms of membership stated above.
Signature: ____________________________ Date: ______________
|
Send completed and signed application with check payable to:
Alternative Health Insurance Services
P.O. Box 370403
Las Vegas, NV 89137
(800) 331-2713
Completed application and payment must be received by the 1st of the month when you are requesting coverage to start.
|
|