University
of Oklahoma (OU) - Student Vision Services Plan
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| OU
Student Vision Services Plan Design: |
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| For
information regarding your current services available,
and for a listing of VSP providers, |
| please visit the VSP website at www.vsp.com
and click on the members box on the right hand side. |
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| In-Network
Exam: |
| One
Exam,
with a $15 Co-Pay, Plan pays the balance. |
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| In-Network
Lenses: |
One
Set of Lenses,
with a $25 Co-Pay, Plan pays the balance for
single, bi-focal, and tri-focal lenses.
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| In-Network
Frames: |
| One
set of frames,
plan pays upto $130, member receives 20% for amounts
over $130. |
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| In-Network
Contacts: |
| One
set of contacts, in
leiu of Lenses & Frames, plan pays up to $120,
member recives 20% for amounts over $120. |
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| In-Network
Options: |
| Tints:
Discounted |
| Dyes:
Discounted |
| Progressive
Lenses for Children: 100% Covered |
| Progressive
Lenses for Adults: Discounted |
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Rates:
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Due
to the volatility of student benefit eligibility,
and the fact of all benefits becoming available on
the first day of coverage, it is necessary that the
entire payment is collected upon enrollment, additionally,
if paying with a credit card, a small handling charge
is also applied, we regret that at this time we are
unable to except monthly payments for this service
plan type.
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Due to High Utilization of this Plan the Student Rate has recently changed |
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Equivalent Monthly
Fee |
Complete
Service Fee |
Credit
Card Handling Fee |
Total |
| Student Only: |
$10.45 |
$113.40 |
$3.76 |
$129.16 |
| Student & Spouse: |
$17.95 |
$215.40 |
$5.05 |
$220.45 |
| Student & Child(ren): |
$18.95 |
$227.40 |
$5.35 |
$232.75 |
| Student & Family: |
$29.95 |
$359.40 |
$8.35 |
$367.75 |
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| Some
Useful Documents: |
| Plan
Summary (pdf 709Kb) |
| Vision
Facts & Stats (pdf 1.36Mb) |
| New
Member Letter (pdf 1.39Mb) |
| HIPAA
Privacy Notice (pdf 47Kb) |
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| Please Note: |
Coverage
is subject to verification of eligible student status.
Your coverage and premium payment is pending
until this has been verified by the university. You will
receive an email confirmation upon completion of this process
welcoming you to your new vision plan. |
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| Begin
Enrollment Here (All
Fields are Required): |
| Members
First Name: |
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| Members
Last Name & Suffix: |
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| Members
Gender: |
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| Members
Birth Date: |
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| Members
Student ID: |
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| Members
Address Line 1: |
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| Members
Address Line 2: |
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| Members
City: |
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| Members
State & Zip Code: |
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| Members
Email Address: |
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| Acknowledgements (Please
Check all 3 boxes, or we cannot accept your enrollment): |
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I
understand that this is not insurance. I understand that
this is an offer in consideration of a one-time payment
of a
professional eye exam for $15, and a set of glasses for $25
with frames of up to $130 in value, or I may in substitute
of the
glasses receive contact lenses & fitting up to $120 in
value. |
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Please
Acknowledge Here: |
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I understand that I have 12 months beginning the 1st day of
the month after the date of my payment to utilize these offered
services; at the end of which, if I have not fully made use of
these services, I understand that I will forfeit whatever remains. |
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Please Acknowledge
Here: |
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I understand that having made my payment for this offered service,
and having received confirmation from USAvision of my acceptance
for this service, that from the 1st day of the month following
my payment, that there is no longer a possibility of either a
full or partial refund. |
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Please Acknowledge
Here: |
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