Cypress-Fairbanks Independent School District

Guardian VSP Vision Insurance Plan

Guardian VSP Provider Network

Guardian Notice of Privacy Practices

Group Plan Number: 00460832

Helpline: 888-600-1600
Hours: 8:00 a.m. to 8:30 p.m., 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 $10.36
Employee and Spouse $17.44
Employee and Child(ren) $17.80
You, Spouse and Child(ren) $28.18
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 a.m. to 8:30 p.m., 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