basic vision coverage

overview

If you are enrolled in the Medical PPO Plan, the High Deductible Health Plan (HDHP), the High Deductible Health Plan Basic (HDHP Basic), a Medical HMO Plan, or either of the Global Choice plans, then you’re also automatically enrolled in basic vision coverage.

If you are enrolled in a Chevron Medical HMO Plan, your HMO Plan provides basic vision coverage. Your HMO Plan in the insurer of your basic vision coverage. To learn more about the basic vision coverage available through your HMO Plan, contact your HMO plan directly.

If you are enrolled in the Medical PPO, the HDHP, the HDHP Basic, then you’re also automatically enrolled in the Chevron Vision Program for basic vision coverage. VSP is the insurer for the Chevron Vision Program.

  • Contact VSP if you have questions about your vision coverage.
  • Plan group number: 30021085
  • Chevron Vision Program summary plan description
  • 2018 Vision benefit summary
  • VSP website
  • VSP claim form - The deadline to submit claims for out-of-network basic expenses is 365 days from the date of service. Keep in mind that you don’t always need to file a claim. If you received services from a network provider, a claim was automatically filed for you. If you have questions, contact VSP directly.

If you are enrolled in the Global Choice Plan (U.S.-Payroll Expatriate), then you’re also automatically enrolled in the Chevron Vision Program for basic vision coverage. VSP is the insurer for the Chevron Vision Program. 

If you receive covered services outside the U.S., the nonpreferred (out-of-network) level of benefits will apply. However, if you use a VSP preferred provider while you're in the U.S., the preferred provider level of benefits will apply for covered materials and services.

  • Contact VSP if you have questions about your vision coverage.
  • Plan group number: 30021085
  • Chevron Vision Program summary plan description
  • 2018 Vision benefit summary
  • VSP website
  • VSP claim form - The deadline to submit claims for out-of-network basic expenses is 365 days from the date of service. Keep in mind that you don’t always need to file a claim. If you received services from a network provider, a claim was automatically filed for you. If you have questions, contact VSP directly.

If you are enrolled in the Global Choice Plan (Expatriates in the U.S.), then you’re also automatically enrolled in the Chevron Vision Program for basic vision coverage. VSP is the insurer for the Chevron Vision Program. 

If you receive covered services outside the U.S., the nonpreferred (out-of-network) level of benefits will apply. However, if you use a VSP preferred provider while you're in the U.S., the preferred provider level of benefits will apply for covered materials and services.

  • Contact VSP if you have questions about your vision coverage.
  • Plan group number: 30021085
  • Chevron Vision Program summary plan description
  • 2018 Vision benefit summary
  • VSP website
  • VSP claim form - The deadline to submit claims for out-of-network basic expenses is 365 days from the date of service. Keep in mind that you don’t always need to file a claim. If you received services from a network provider, a claim was automatically filed for you. If you have questions, contact VSP directly.

preventive care

If you are enrolled in a Chevron medical plan, your basic vision coverage includes 100 percent coverage for an annual comprehensive eye exam, including dilation as needed, from a network provider. Contact your basic vision insurer to understand what’s available.

find a network provider

The VSP provider network is made up of primarily private-practice vision providers across the United States. All VSP private practice doctors provide exams and have materials, such as glasses and contacts, available in their office. You still have the option to see an out-of-network provider for exams or to purchase materials if you desire. But note that the out-of-network benefit will apply and you'll generally have to submit a claim to VSP for reimbursement.

retail chain network providers 

VSP members can choose to see a VSP doctor, a participating retail chain provider, or an out-of-network provider. You can choose to visit a Retail Chain Affiliate Provider for added convenience and additional retail locations. These providers are network providers, so network benefits will apply. Retail Chain Affiliate Providers include Visionworks, WisconsinVision, Heartland Vision, Rx Optical and Cohen's.

did you know? 

We know many employees use Costco for their prescription eyewear. Costco is an out-of-network provider, so out-of-network benefits will apply. But, unlike other out-of-network providers, Costco can submit your claim to VSP. In addition, out-of-network coverage with Costco includes standard progressive lenses fully covered after a $40 copayment.

Please note: This page applies to U.S.-payroll employees. This page provides only certain highlights of benefits or program provisions. It is not intended to be a complete explanation. If there are any discrepancies between this communication and legal plan documents, the legal documents will prevail to the extent permitted by law. This is not a plan text or a summary plan description. There are no vested rights with respect to Chevron health care plans or any company contributions toward the cost of such health care plans. Rather, Chevron Corporation reserves all rights, for any reason and at any time, to amend, change or terminate these plans or to change or eliminate the company contribution toward the cost of such plans. Such amendments, changes, terminations or eliminations may be applicable without regard to whether someone previously terminated employment with Chevron or previously was subject to a grandfathering provision. Some benefit plans and policies described in this document may be subject to collective bargaining and, therefore, may not apply to union represented employees.