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VSP <br />Monthly Rates <br />Vision <br />Employee <br />Family <br />TIER 1 <br />TIER 2 <br />Employee <br />Share <br />City <br />Share <br />Total <br />Premium <br />Employee <br />Share <br />City <br />Share <br />Total <br />Premium <br />$0.00 <br />$10.58 <br />$10.58 <br />$1.32 <br />$9.26 <br />$10.58 <br />$5.00 <br />$17.75 <br />$22.75 <br />$7.22 <br />$15.53 <br />$22.75 <br />VSP <br />Benefits Summary <br />Type of Service <br />Exam <br />Lenses/Frames <br />Contact Lenses <br />Coverage <br />Exams <br />Lenses <br />Frames <br />NO PREMIUM <br />OR PLAN <br />DESIGN <br />CHANGES <br />Contact Lenses <br />In -Network <br />$10 copay <br />$25 combined copay <br />No copay for elective contact lenses <br />Every 12 months <br />Every 12 months <br />Up to $130 every 24 months <br />—OR— <br />Up to $130 every 12 months <br />*Out -of -Network benefits are significantly reduced. For details refer to the VSP Plan document. <br />Flexible Spending Accounts (FSA) <br />Flexible Spending Account <br />An Internal Revenue Service Section 125 (Flexible Benefits) Plan is available for you to set aside a portion of <br />your salary to pay for non -reimbursed medical expenses, childcare expenses and non -paid insurance premium <br />expenses. <br />A Section 125 cafeteria plan offers you two ways to save on the amount of taxes you pay each year: <br />1. Medical Spending Account (INCREASED LIMIT for 2017) <br />a. Allows you to pay for medical expenses not covered by your medical plan <br />b. City of Louisville allowable maximum is $2600.00 <br />2. Dependent Care Spending Account <br />a. Allows for pre-tax deductions to pay for dependent care expenses <br />b. City of Louisville allowable maximum is $5000.00 <br />Contributions to flexible spending accounts are deducted before FICA, federal income tax and most state and <br />local tax deductions are taken. This means you pay less tax because your taxable income has been reduced. <br />Another advantage to using a flexible spending account is that you don't pay taxes on the reimbursable <br />amounts either. Note: A spouse of a Domestic Partner relationship is not eligible to claim health care or <br />dependent care expenses on a pre-tax basis. <br />8 <br />