Vision Program

If you're a permanent State Employee working half-time or more, you're eligible for the State's Vision Program. You may receive an eye examination, lenses and a frame once every calendar year. Vision Service Plan (VSP) provides vision coverage under its Regional Network Plan.

The State now offers a Retiree Vision Program. Please see the Retiree Vision Program for more information.

Information

• Enrollment
• Vision Carrier
• Premiums and Deductibles
• COBRA Continuation Coverage

Publications

• Evidence of Coverage Booklet (133 KB PDF)

Forms

• Vision Plan Enrollment Authorization - STD 700 (PDF)
• Vision Plan Direct Payment Authorization - STD 703 (PDF)
• Retiree Vision Plan Deduction and Enrollment Authorization - DPA 695 (PDF)
• Vision Services Plan Brochure/Enrollment Form (PDF)

COBRA Forms

• COBRA Initial General Notice (Word Document)
• COBRA Initial General Notice Log (Word Document)
• COBRA Election Notice (Word Document)
• COBRA Election Notice Log (Word Document)
• COBRA Election Form (PDF)
• COBRA Notice of Unavailability of Continuation Coverage (Word Document)
• COBRA Monthly Status Report (Word Document)
• COBRA Calendar (PDF)
• COBRA Premium Assistance and Election Notice - American Reinvestment and Recovery Act of 2009 (PDF)

For More Information

Please contact your personnel office if you have any questions.

Updated March 18, 2009 at 4:32 PM.