Vision Insurance & Additional Discounts Info
- We accepted by all major vision insurance plans
- VSP Vision Insurance
- We supply your insurance company’s claim form
- We complete and submit claim on your behalf
RAIN OR SHINE OPTIQUE is accepted by all major vision insurance plans including VSP Vision Insurance as an out-of-network provider. You can use your insurance to buy eye glasses and prescription lenses from us and then simply put in your claim for the out-of-network reimbursement. We can supply you with your insurance company’s claim form and are also happy to complete and submit it on your behalf.
In addition, we offer VSP members an additional 25% discount on frames plus reduced pricing on lenses. Therefore, by combining your out-of-network benefits with the plan member discount offered by RAIN OR SHINE OPTIQUE, your costs can be roughly comparable with your in-network reimbursement while you get to select your new eyewear from the finest selection of eye glass and sunglass frames in the area. We also have a full assortment of stylish, but very functional safety frames.
VISION INSURANCE PLAN (VSP) COMPARISON
The table below indicates examples of the the standard benefits offered by VSP in California. Note, however, that there are different plans and each plan has various options.
| VISION CARE SERVICE | VSP Network Benefit* | Non-VSP Provider Benefit* | Rain or Shine Insurance Member Pricing | Cost to VSP Member at Rain or Shine* | Cost to VSP Member at Network Doctor* |
|---|---|---|---|---|---|
| (A) | (B) | (A+B) | |||
| Frame | Covered up to over allowance | $25-40 | 25% discount | Frame cost: $150 Frame cost: $250 Frame cost: $350 |
Frame cost: $150 Frame cost: $250 Frame cost: $350 |
| (Available once each 12 months) |
(Unlimited) | ||||
| Sunglasses | Not covered | Not covered | 25% discount | 20% discount | |
| Standard Plastic Lenses | |||||
| Single Vision | Covered in full | $26 | $55 | $29 | $0 |
| Bifocal | Covered in full | $43 | $85 | $42 | $0 |
| Trifocal | Covered in full | $60 | $115 | $55 | $0 |
| Lens Options (Extra Cost) | (Estimated) | ||||
| UV Coating/Treatemnt | Not covered | Not covered | $15 | $15 | $15 |
| Tint (Solid or Gradient) | Not covered | Not covered | $15 | $15 | $15 |
| Scratch-Resistant Coating | Not covered | Not covered | $15 | $15 | $15 |
| Trivex Material | Not covered | Not covered | $60 | $34($60-26) | $60 |
| (add-on to single vision) | Premium Zeiss AR | Non-Premium AR | |||
| Anti-reflective Coating | Not covered | Not covered | $70 | $45 | |
| Standard Progressive | Not covered | Not covered | $75 | $75 ($135 - 60) | $65 |
| (add-on to trifocal) | Not covered | Not covered | |||
| Premium Progressive | Not covered | Not covered | $150 discount | $150 off plus $60 | 80% less $50-55 |
| Other Add-ons/Services | Not covered | Not covered | 20% discount | 80% | 80% |
Benefits for lenses and frames include reimbursement for the following necessary professional services performed by the Optican at Rain or Shine:
- Prescribing and ordering proper lenses;
- Assisting in frame selection;
- Verifying accuracy of finished lenses;
- Proper fitting and adjustments of frames;
- Subsequent adjustments to frames to maintain comfort and efficiency;
- Progress or follow-up work as necessary;
- One re-do at no charge whether lab or doctor error.
* Less any applicable Copayment
In-network plans can only be used once a year or once every two years, but the RAIN OR SHINE discount can be used an unlimited number of times.
In-Network Benefits
In-network benefits means that you must buy glasses from the designated eye doctors’ offices. Your in-network eyewear options will be limited to the frames and lenses and pricing offered by that office.
If you stay in your network, you may have a co-payment of anywhere from $10 to $20 for frames and lenses. You get an eyeglass frame allowance of typically up to $100-120 but if the frame costs more than that, you pay 80% on the difference. Lenses are free only if they are regular plastic (single vision, bifocals, and trifocals). If you want a polycarbonate or trivex lens the cost is $50 and more and $75 and upwards for regular plastic progressive lens.
Vision insurance has fixed rates for lens options, but the fees are comparable or not much lower in most cases than the fees for the same options at RAIN OR SHINE. Vision insurance plans have other restrictions, and your plan may vary from the standard scenario we have outlined above. For example, you are only allowed one pair of eyeglasses each year or each two years, depending on your plan, regardless of whether you break or lose your glasses. Eyeglasses frames with non-prescription lenses are excluded. And you can only use your insurance at participating providers.
Discount Plan
If you have a VSP discount plan it gives you discounts on eyeglass frames and fixed prices on lenses and lens options. You can use the plan as many times during the year as you like. However, RAIN OR SHINE offers a 25% discount off our already competitive prices on frames and very competitive prices on lenses and service.
Flex Spending Accounts
At the beginning of each plan year, you choose to have some of your pre-tax income put into a special Flex Spending account. You can choose to use this fund for certain expenses, like medical co-payments, certain child care expenses, and prescription glasses. If you do not use up all of the funds in the Flex Spending account during the Plan year, the excess funds are given away and they do not roll over to the next plan year. Use them, or lose them.
Flex spending funds can be used on eyeglass frames and lenses, and sunglasses, and reading glasses and there is no limit to the number of frames and lenses you can purchase during the year.
Many flex spending plans usually issue a debit card to their members that can be used at approved outlets to purchase approved medical devices, products and services up to the limit of funds still available in your plan. Please note that you can use your flex account card at RAIN OR SHINE. Or you can simply submit your RAIN OR SHINE receipt to your plan administrator and they will reimburse you.